Koo Ja Ho, Hwang Eui Hyun, Song Ji Hye, Lim Yong Cheol
Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
J Korean Neurosurg Soc. 2024 Aug;67(5):531-540. doi: 10.3340/jkns.2023.0224. Epub 2023 Dec 22.
The use of reconstructive treatment with a double-overlapping stents has proven to be effective and safe in the current treatment of intracranial vertebral artery dissecting aneurysms (VADAs). We employed a combination of overlapping stents, using low-profile visualized intraluminal support (LVIS) within the Enterprise stent. This combination was chosen to minimize the outward bulging of the inner LVIS by overlapping it with the Enterprise stent while maintaining flow diversion and stability. This study aimed to evaluate the clinical and angiographic outcomes following the use of double-overlapping stents with LVIS within the Enterprise stent for the treatment of VADAs.
From March 2016 to January 2022, total 28 patients with unruptured VADAs were treated with the double-overlapping stent technique using LVIS within an Enterprise stent in our institute. The Enterprise stent was deployed first, followed by the LVIS stent. Patient clinical and angiographic characteristics, procedural complications, and follow-up outcomes were retrospectively reviewed.
All 28 patients (18 males and 10 females) were successfully treated with double-overlapping stent deployment. There were no procedural complications or new neurological deficits in any patient. Of the 28 patients, four VADAs had posterior inferior cerebellar artery involvement. Procedure-related parent artery occlusion did not occur during the angiographic follow-up conducted 6 to 12 months after the procedure. Out of 28 patients, 24 showed complete healing, three had focal residual stenosis or dilatation with residual sac and only one had a residual dissecting flap with aneurysm. All patients, including the four patients, did not require any additional procedures. The postoperative modified Rankin scale scores were 0-1 for all patients.
A double-overlapping stent, with a flow-diversion effect, is a safe and effective treatment for patients with VADAs. In particular, when using the LVIS stent within an Enterprise stent, it minimizes the bulging of the inner LVIS stent while maintaining flow diversion and stability. Therefore, both can be effectively utilized as overlapping stents.
在颅内椎动脉夹层动脉瘤（VADA）的当前治疗中，使用双重叠支架进行重建治疗已被证明是有效且安全的。我们采用了重叠支架的组合，在Enterprise支架内使用低轮廓可视化腔内支撑（LVIS）。选择这种组合是为了通过将内部LVIS与Enterprise支架重叠，在保持血流转向和稳定性的同时，尽量减少内部LVIS的向外膨出。本研究旨在评估在Enterprise支架内使用带LVIS的双重叠支架治疗VADA后的临床和血管造影结果。
2016年3月至2022年1月，在我们研究所，共有28例未破裂VADA患者采用在Enterprise支架内使用LVIS的双重叠支架技术进行治疗。先部署Enterprise支架，然后部署LVIS支架。对患者的临床和血管造影特征、手术并发症及随访结果进行回顾性分析。
所有28例患者（18例男性和10例女性）均通过双重叠支架置入成功治疗。所有患者均未出现手术并发症或新的神经功能缺损。28例患者中，4例VADA累及小脑后下动脉。在术后6至12个月进行的血管造影随访中，未发生与手术相关的母动脉闭塞。28例患者中，24例显示完全愈合，3例有局灶性残余狭窄或扩张伴残余囊，仅1例有残余夹层瓣伴动脉瘤。所有患者，包括这4例患者，均无需任何额外手术。所有患者术后改良Rankin量表评分为0 - 1分。
具有血流转向作用的双重叠支架对VADA患者是一种安全有效的治疗方法。特别是在Enterprise支架内使用LVIS支架时，它在保持血流转向和稳定性的同时，使内部LVIS支架的膨出最小化。因此，两者均可有效地用作重叠支架。
