Willis覆膜支架治疗颅段颈内动脉动脉瘤的前瞻性研究  

Treatment of distal internal carotid artery aneurysm with the willis covered stent:a prospective pilot study

作　　者：孙贞魁[1] 李永东[1] 李明华[1] 谭华桥[1] 王武[1] 罗七一[1] 程英升[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

出　　处：《介入放射学杂志》2010年第4期263-268,共6页Journal of Interventional Radiology

基　　金：国家自然科学基金面上项目(305708540)

摘　　要：目的评价Willis覆膜支架治疗颅段颈内动脉(ICA)动脉瘤的柔顺性和疗效。方法31例患者33枚颅段ICA(CICA)动脉瘤患者接受Willis覆膜支架治疗。根据血管造影表现,分为完全栓塞和不完全栓塞。术后第1,3,6,12个月及之后每年1次随访复查并收集最初及最终造影结果、死亡率、致残率及最终临床结果等数据。结果42枚覆膜支架中41枚顺利通过ICA并成功释放,成功率97.6%(95%CI:93%～102%)。术后即刻造影显示,23例患者中25枚为完全栓塞,占78.1%(95%CI:63%～93%);7例患者7枚动脉瘤为不完全栓塞(21.9%)。随访血管造影示27例患者共31枚动脉瘤,其中29枚完全栓塞,占93.5%(95%CI:84%～103%);2例为不完全栓塞(6.5%),其中2例患者出现轻度支架内狭窄。临床随访显示15例患者痊愈,14例症状改善。结论初步结果显示,Willis覆膜支架治疗CICA动脉瘤有效且具有良好的柔顺性,但仍需长期随访及大样本临床研究。Objective To evaluate the flexibility and efficacy of the Willis covered stent in the treatment of distal internal carotid artery（DICA） aneurysms.Methods The study was approved by the authors＇ institutional review board,and the research was conducted by the authors＇ institution and the MicroPort Medical Company（Shanghai,China）.Thirty-one patients with 33 DICA aneurysms were considered for treatment with a Willis covered stent.The angiographic assessments were categorized as complete or incomplete occlusion.The data on technical success,initial and final angiographic results,mortality,morbidity,and final clinical outcome were collected,and follow-up was performed at 1,3,6,and 12 months and yearly after the procedures.Results Navigation and deployment of the covered stents were successful in 97.6%（41 of 42;95% confidence interval [CI]： 93%,102%） of the attempted stent placement procedures.The initial angiographic results showed a complete occlusion in 23 patients with 25 aneurysms（of 32 aneurysms,78.1% [95% CI： 63%,93%]） and an incomplete occlusion in seven patients with seven aneurysms（21.9%）.The angiographic follow-up（mean,14 months [95% CI： 12,15 months]） findings exhibited a complete occlusion in 27 patients with 29 aneurysms（of 31 aneurysms,93.5% [95% CI： 84%,103%]） and an incomplete occlusion in two aneurysms（6.5%）,with a mild in-stent stenosis in two patients.The clinical follow-up（mean,27 months [95% CI： 23,30 months]） demonstrated that 15 patients experienced a full recovery and 14 patients improved.Conclusion The preliminary results demonstrate good flexibility and efficacy of the Willis covered stent in the treatment of DICA aneurysms in selected patients;longer follow-up and expanded clinical trials are needed.

关 键 词：数字减影血管造影 颈内动脉 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]