支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤

doi:10.3969/j.issn.1673-5765.2021.06.003

摘要/Abstract

摘要： 目的分析支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤的安全性和有效性。方法该回顾性研究纳入昆明医科大学第二附属医院脑血管病科2016年7月-2020年7月经DSA诊断的应用支架辅助栓塞治疗的前交通动脉宽颈动脉瘤患者。收集所有患者的临床相关资料，评价支架辅助栓塞治疗的疗效和安全性。治疗技术指标采用术后即刻DSA Raymond分级评价动脉瘤栓塞程度。疗效指标包括术后6个月DSA影像随访动脉瘤情况及mRS评分（≤2分定义为预后良好），安全性指标包括缺血、出血等围手术期相关并发症。结果共纳入32例患者，其中破裂动脉瘤22例；未破裂动脉瘤10例。22例破裂动脉瘤中Hunt-Hess 分级3～4级10例（45.45%）。32个动脉瘤最长径中位值4.98（3.00～8.13）mm。术后即刻栓塞程度 Raymond Ⅰ级28例（87.50%）。术中支架内血栓形成3例（9.38%），术后动脉瘤再出血1例（3.13%），死亡2例（6.25%），其中1例因术后再出血，另1例因术中支架内血栓形成。余30例患者术后6个月复查 DSA，动脉瘤均无复发，预后良好26例（81.30%）。结论根据前交通动脉瘤及载瘤动脉特点采取个体化的支架辅助弹簧圈栓塞技术治疗前交通动脉宽颈动脉瘤安全有效。

文章导读： 前交通动脉复合体解剖较为复杂。采用个体化的支架辅助弹簧圈栓塞技术治疗前交通动脉宽颈动脉瘤能使患者获得良好预后，有较好的安全性和有效性。

关键词: 支架辅助弹簧圈栓塞; 宽颈; 前交通动脉瘤

Abstract: Objective To analyze the safety and efficacy of stent-assisted coil embolization of wide-necked anterior communicating artery aneurysms (ACoAA). Methods The patients with wide-necked ACoAA diagnosed by DSA who were treated by stentassisted coil embolization at Department of Cerebrovascular Disease, The Second Affiliated Hospital, Kunming Medical University between July 2016 and July 2020 were included in this retrospective analysis. The clinical relevant data of all patients were collected and analyzed to evaluate the technical feasibility (modified Raymond-Roy occlusion classification at end of precedure), periprocedural complications, aneurysm occlusion (6-month DSA imaging followup), and clinical outcome (mRS score at 6-month follow-up, good prognosis was defined as a mRS score of 0-2). Results A total of 32 patients were included, including 10 ones with unruptured aneurysms and 22 with ruptured aneurysms, of which 10 cases (45.45%) with ruptured aneurysms for Hunt-Hess grade 3-4. The median maximum aneurysm diameter of 32 aneurysms were 4.98 (3.00-8.13) mm. For aneurysm occlusion evaluation, Raymond grade I occlusion (near-complete) was obtained in 28 cases (87.50%). Intraprocedural in-stent thrombosis occurred in 3 cases (9.38%), postprocedural aneurysm rebleeding occurred in 1 case (3.13%), and 2 cases (6.25%) died from postprocedural rebleeding and in-stent thrombosis, respectively. The 6-month DSA follow-up showed no recurrence of aneurysms. 26 cases (81.30%) had a good prognosis at 6-month follow-up. Conclusions The individualized stent-assisted coil embolization of wide-necked ACoAA can be effective and safe.

Key words: Stent-assisted coil embolization; Wide-necked; Anterior communicating artery aneurysm

陈柏宇, 曹毅, 鲍娟, 杨勇涛, 景睿, 李云飞, 胡佳怡, 赵青. 支架辅助弹簧圈栓塞治疗前交通动脉宽颈动脉瘤[J]. 中国卒中杂志, 2021, 16(06): 544-550.

CHEN Bo-Yu, CAO Yi, BAO Juan, YANG Yong-Tao, JING Rui, LI Yun-Fei, HU Jia-Yi, ZHAO Qing. Analysis of Stent-assisted Coil Embolization of Wide-necked Anterior Communicating Artery Aneurysms[J]. Chinese Journal of Stroke, 2021, 16(06): 544-550.

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