支架联合弹簧圈技术栓塞颅内微小宽颈动脉瘤  

Endovascular stenting combined with coiling for treatment of intracranial

作　　者：辛涛[1] 陈峰[1] 林军[1] 高述礼[1] 祝宏春[1] 彭均[1] 顾正云[1] 

机构地区：[1]青岛解放军第401医院神经外科,266071

出　　处：《介入放射学杂志》2004年第S1期58-61,共4页Journal of Interventional Radiology

基　　金：青岛市科技计划发展项目 ( 0 4 2 NY 46)

摘　　要：目的　探讨三维 (3D)数字减影 (DSA)辅助下血管内支架联合弹簧圈 (stent coil)技术栓塞颅内微小宽颈动脉瘤的技术要点及疗效。方法　 12例瘤体 颈比值≤ 1的颅内微小宽颈动脉瘤 (瘤体最大径≤ 4 .0mm) ,全部经二维 (2D)造影及 3D重建 ,前交通动脉 2例采用双侧置管 ,微导管头端到位后 ,通过对侧导引导管内释放颅内自膨胀支架Neuroform ,再通过微导管使用弹簧圈塞动脉瘤。后交通动脉 8例 ,小脑后下动脉动脉起始部 2例 ,先释放支架覆盖瘤颈 ,通过支架网眼将微导管送入动脉瘤腔使用弹簧圈栓塞 ,术后 6～ 12个月进行临床和影像学随访。结果　 12例 2DDSA检查中 7例需经 3D确定为宽颈动脉瘤 ;12例全部技术成功 ,动脉瘤致密栓塞 ,载瘤动脉通畅 ;1例前交通动脉瘤栓塞后出现一过性神经功能障碍 ,经治疗后恢复正常 ,其余 11例恢复顺利。 12例临床随访 6～ 12个月 ,无动脉瘤再出血或脑血栓形成 ,7例DSA随访 ,无支架内膜增生狭窄及动脉瘤复发。结论　 3DDSA在颅内微小宽颈动脉瘤的诊断和介入治疗中有重要的辅助作用 ,支架～弹簧圈技术栓塞颅内微小宽颈动脉瘤疗效确实 ,颅内专用支架为特殊部位宽颈动脉瘤的介入治疗提供了方便。Objective To invesigate the technique and efficacy of endovascular stenting combined with coiling for treatment of intracranial wide-necked microaneurysms with the assistance of three-dimensional(3D) DSA.Methods Twelve cases of intracranial wide-necked microaneurysms(proportionality of aneurysm body/neck≤1)performed 2D and 3D angiography.In the treatment of two AcoA aneurysms,the guidings were implanted bilaterally,the intracranial self-expanding stents Neuroform were implanted after the tips of microcatheter entered the cavity of aneurysms through the contralateral guiding.The microaneurysms were embolized with coils through the microcatheters after the stents were implanted.In the treatment of eight PCoA and 2 PICA wide-necked microaneurysms,the stents were impanted across the neck of aneurysms.Then the microcatheters were introduced into the aneurysm sac through stent mesh and the coils were used to embolize the aneurysms.Clinic and angiogram follow-up performed for 6～12months. Results 7 of 12 cases were not clear according to 2D DSA and were determined to be wide-necked microaneurysms with the assistant of 3D images. The treatment succeeded in all 12 cases and the aneurysms were completely embolized with the parent artery unaffected.One patient of AcoA aneurysm had temporary mild neurodeficit and quickly recovered after treatment.The other 11 cases recoverd well.No re-bleeding or symptom related to thrombosis occurred during clinic follow-up fou 6-12months.Follow-up angiogram in 7 cases showed no stenosis in segment of the stent and no aneurysmal recurrence.Conclusions 3D DSA would be a useful tool in the diagnosis and interventional treatment of intracranial wide-necked microaneurysms.Stent-coil technique would be a valid method for the treatment of intracranial wide-necked microaneurysms.Intracranial self-expanding stent may make it easy and feasible for the treatment of wide-necked anwurysms on special location.

关 键 词：三维数字减影 宽颈动脉瘤 支架 介入治疗 

分 类 号：R739.4[医药卫生—肿瘤]