Analysis of Stent-assisted Coil Embolization of Wide-necked Anterior Communicating Artery Aneurysms

doi:10.3969/j.issn.1673-5765.2021.06.003

Abstract

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

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。

关键词: 支架辅助弹簧圈栓塞; 宽颈; 前交通动脉瘤

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.

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.

References

[1] BRZEGOWY P，KUCYBALA I，KRUPA K，et
al. Angiographic and clinical results of anterior
communicating artery aneurysm endovascular
treatment[J]. Wideochir Inne Tech Maloinwazyjne，
2019，14（3）：451-460.
[2] SEKHAR L N，NATARAJAN S K，BRITZ
G W，et al. Microsurgical management of
anterior communicating artery aneurysms[J/
OL]. Neurosurgery，2007，61（5 Suppl 2）：273-
290[2021-02-08]. https：//doi.org/10.1227/01.
neu.0000303980.96504.d9.
[3] HERNESNIEMI J，DASHTII R，LEHECKA M，
et al. Microneurosurgical management of anterior
communicating artery aneurysms[J]. Surg Neurol，
2008，70（1）：8-28.
[4] LI J W，SHI C H. Endovascular treatment of
complicated ruptured anterior communicating artery
aneurysms based on the anatomical features of the
anterior communicating artery complex[J]. Neurol
India，2012，60（1）：55-60.
[5] 黄清海，刘建民，杨鹏飞，等. 支架后释放技术在颅
内宽颈动脉瘤栓塞治疗中的应用[J]. 中华脑血管病
杂志（电子版），2009，3（5）：208-213.
[6] INAGAWA T. Risk factors for the formation and
rupture of intracranial saccular aneurysms in
Shimane，Japan[J]. World Neurosurg，2010，73（3）：
155-164.
[7] KEEDY A. An overview of intracranial
aneurysms[J]. Mcgill J Med，2006，9（2）：141-146.
[8] YANG F，LI H，WU J，et al. Relationship of
A1 segment hypoplasia to the radiological and
clinical outcomes of surgical clipping anterior
communicating artery aneurysm[J]. World
Neurosurg，2017，106：806-812.
[9] MOON K，LEVITT M R，ALMEFTY R O，et al.
Treatment of ruptured anterior communicating artery
aneurysms：equipoise in the endovascular era?[J].
Neurosurgery，2015，77（4）：566-571.
[10] 周祥，周文科，张新中，等. 前交通动脉复合体区的显
微解剖学研究[J]. 医学信息（手术学分册），2006，19
（3）：56-59.
[11] BRZEGOWY P，KUCYBALA I，KRUPA K，et
al. Angiographic and clinical results of anterior
communicating artery aneurysm endovascular
treatment[J]. Wideochir Inne Tech Maloinwazyjne，
2019，14（3）：451-460.
[12] BERETTA F，ANDALUZ N，ZUCCARELLO
M. Aneurysms of the ophthalmic（C6）segment of
the internal carotid artery：treatment options and
strategies based on a clinical series[J]. J Neurosurg
Sci，2004，48（4）：149.
[13] SLUZEESKI M，VAN ROOIJ W J，SLOB M J，et al.
Relation between aneurysm volume，packing，and
compaction in 145 cerebral aneurysms treated with
coils[J]. Radiology，2004，231（3）：653-658.
[14] GEYIK S，YAVUZ K，YURTTUTAN N，et al.
Stent-assisted coiling in endovascular treatment of
500 consecutive cerebral aneurysms with long-term
follow-up[J]. AJNR Am J Neuroradiol，2013，34

（11）：2157-2162.

[15] FENG Z Z，FANG Y B，XU Y，et al. The safety
and efficacy of low profile visualized intraluminal
support（LVIS）stents in assisting coil embolization
of intracranial saccular aneurysms：a single center
experience[J]. J Neurointerv Surg，2016，8（11）：
1192-1196.
[16] TARULLI E，FOX A J. Potent risk factor for
aneurysm formation：termination aneurysms of the
anterior communicating artery and detection of A1
vessel asymmetry by flow dilution[J]. AJNR Am J
Neuroradiol，2010，31（7）：1186-1191.
[17] MHLENBRUCH M，HERWEH C，BEHRENS L，et
al. The LVIS Jr. microstent to assist coil embolization
of wide-neck intracranial aneurysms：clinical study
to assess safety and efficacy[J]. Neuroradiology，
2014，56（5）：389-395.
[18] GE H J，LV X L，YANG X J，et al. LVIS stent
versus Enterprise stent for the treatment of
unruptured intracranial aneurysms[J/OL]. World
Neurosurg，2016，91：365-370[2021-02-08]. https：//
doi.org/10.1016/j.wneu.2016.04.057.
[19] 胡骁，周林裕，殷汉荣，等. Lvis支架辅助微弹簧圈
栓塞破裂宽颈前交通动脉动脉瘤的疗效分析[J]. 中
国临床神经外科杂志，2017，22（5）：42-43.
[20] GROSS B A，ARES W J，DUCRUET A F，et al.
A clinical comparison of Atlas and LVIS Jr stentassisted
aneurysm coiling[J]. J Neurointerv Surg，
2019，11（2）：171-174.
[21] ZHANG X X，ZUO Q，TANG H S，et al. Stent
assisted coiling versus non-stent assisted coiling for
the management of ruptured intracranial aneurysms：
a meta-analysis and systematic review[J]. J
Neurointerv Surg，2019，11（5）：489-496.
[22] LANE D A，GRANT P J. Role of hemostatic gene
polymorphisms in venous and arterial thrombotic
disease[J]. Blood，2000，95（5）：1517-1532.
[23] 罗昱，肖绍文，谭源福，等. 前交通动脉瘤形态学特点
与栓塞可行性关系[J]. 临床神经外科杂志，2009，6
（3）：132-134.