颅内覆膜支架治疗颅段颈内动脉病变的初步临床研究  

Preliminary clinical application in the cranial internal carotid artery of covered stents specially designed for intracranial vasculature

作　　者：李明华[1] 王永利 罗七一[1] 方淳 谢志永[1] 程英升[1] 高不郎[1] 李雨[1] 张蓓蕾[1] 谢剑[1] 

机构地区：[1]上海交通大学附属第六人民医院介入影像科,200233 [2]上海第十人民医院介入科

出　　处：《中华放射学杂志》2007年第1期72-76,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金(30570540);上海市医学重点学科基金(05Ⅲ023);上海市领军人才基金(LJ06016)

摘　　要：目的观察采用颅内专用覆膜支架及其输送系统通过颅段颈内动脉(CICA)骨性管道和生理弯曲,治疗颅段颈内动脉病变的效果。方法采用颅内专用覆膜支架,以血管内技术治疗13例 CICA 病变。其中巨大假性动脉瘤4例、巨大动脉瘤4例、宽颈小动脉瘤3例、巨大假性动脉瘤伴颈动脉海绵窦瘘(CCF)1例、CCF 1例。颅内专用覆膜支架释放前均行患侧颈内动脉球囊闭塞试验(BOT)和 DSA。术后3～16个月施行 DSA 随访和临床随访。结果 13例患者 BOT 均耐受良好,DSA证实前、后交通动脉开放良好。13例覆膜支架及其输送系统均顺利通过 CICA 到达病变靶区。病变及覆膜支架释放部位分别为:C3～4段4例、C4～5段4例、C6～7段5例。覆膜支架释放后即刻 DSA示7例动脉瘤不再显影,4例显示少量内漏,1例 CCF 覆膜支架释放后流量明显减少,1例假性动脉瘤伴 CCF 覆膜支架释放后动脉瘤消失,但残存低流量 CCF。13例中1例动脉瘤破裂性蛛网膜下腔出血患者术后9 d 因血管广泛痉挛而死亡。12例随访 DSA 均显示覆膜支架放置处血管通畅,其中2例显示轻度狭窄;6例术后存在内漏,其中4例 DSA 随访7～16个月后内漏消失,1例再次置入覆膜支架治疗后内漏消失;1例 CCF,3个月后随访仍显示低流量瘘。存活患者临床随访3～16个月未发生支架覆盖段相关分支堵塞后的并发症。结论颅内覆膜支架及其输送系统的柔顺性足以使其通过迂曲的 CICA,到达颅内病变血管处,有效治疗 CICA 病变。颅内覆膜支架的远期疗效有待长期随访,其贴壁性能仍需进一步完善。Objective To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery （CICA） to reach the targeted area, the performance （adherence） of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment. Methods The covered stents specially designed for use in intracranial vasculature were used to treat 13 patients with CICA diseases using endovascular techniques. There were 4 huge pseudoaneurysms, 4 giant aneurysms, 3 small wide-necked aneurysms, 1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula （ CCF）, and 1 CCF. Prior to the detachment of the covered stents, balloon occlusion test （BOT） of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography （DSA） were performed in all the patients. Three to 16 months following procedure, DSA and clinical follow-ups were performed. Results Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries. The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area, with the diseased segments of the internal carotid artery including C3-CA in 4 cases, CA-C5 in 4 and C6-C7 in 5. Immediately following the detachment of the covered stents, DSA demonstrated that 7 aneurysms were completely occluded, 4 aneurysms had slight endoleak, and 1 CCF had markedly-decreased blood flow through the fistula. In the patient with concurrent pseudoaneurysm and CCF, the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure. Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting procedure, all the other 12 patien

关 键 词：支架 颈动脉 动脉瘤 颈动脉海绵窦瘘 

分 类 号：R743[医药卫生—神经病学与精神病学]