LVIS支架不同释放方式在颅内宽颈动脉瘤中的应用  

Application of different release modes of LVIS stents in wide-neck intracranial aneurysms

作　　者：陈骅[1] 苏浩波[2] 陈亮[2] 罗良生[1] 顾建平[2] 张健[1] 

机构地区：[1]南京医科大学附属南京医院神经外科,210006 [2]南京医科大学附属南京医院介入血管科,210006

出　　处：《中国脑血管病杂志》2016年第2期82-88,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨评估低剖面可视化腔内支撑装置（LVIS支架）＂压缩＂和＂灯笼＂释放方式治疗颅内宽颈动脉瘤的安全性及短期疗效。方法回顾性连续纳入2014年12月至2015年10月接受LVIS支架治疗且支架形态发生短缩改变的颅内宽颈动脉瘤患者15例（16个动脉瘤）,均经全脑DSA检查明确诊断。＂压缩＂方式指通过操作使LVIS支架长度比标注释放数值短缩超过5 mm;＂灯笼＂方式指瘤颈处LVIS支架直径增宽。计算颈内动脉后交通段内支架压缩后金属覆盖率,并于术后即刻及术后3个月评价其安全性及疗效。结果 （1）采用LVIS支架辅助治疗的16个宽颈动脉瘤中后交通动脉瘤8个,眼动脉瘤6个,脉络膜前动脉瘤及大脑中动脉M2分叉梭形动脉瘤各1个;瘤颈1.8-8.0 mm,平均（3.9±1.7）mm;共置入LVIS支架15枚（1枚支架治疗两个动脉瘤者1例）;均采用＂压缩＂方式释放支架,其中4例（4枚）同时并存＂灯笼＂方式。（2）LVIS支架术后Raymond分级Ⅰ级栓塞10个（62.5%）,覆盖的分支动脉术后即刻均通畅。（3）围手术期未发生技术相关出血性和缺血性并发症,支架置入成功率100%（15/15）。（4）颈内动脉后交通段内支架压缩后金属覆盖率为30.3%-38.5%,平均（35.0±2.8）%。（5）15例LVIS支架置入术后患者均经全脑DSA随访3-5个月,平均（3.2±0.5）个月,其中14个动脉瘤达影像学治愈（RaymondⅠ级,87.5%）,无动脉瘤复发病例。支架覆盖的所有分支动脉无闭塞,未发生支架内狭窄及载瘤动脉闭塞,总致残率为6.7%（1/15）,无死亡病例。结论 LVIS支架通过＂压缩＂及＂灯笼＂方式可提高瘤颈金属覆盖率和短期治愈率,同时不影响覆盖的分支动脉。选择适宜病例行＂灯笼＂方式可能有利于瘤颈处分支动脉的短期保护。Objective To investigate the safety and short-term efficacy for evaluation of the lowprofile visualized intraluminal support device（ LVIS stents） ＂ compression＂ and ＂ lantern＂ release shapes for the treatment of wide-necked intracranial aneurysms. Methods From December 2014 to October2015,15 patients with intracranial wide-neck aneurysm（ 16 aneurysms） received LVIS stent treatment,whose stent shapes had shortening changes were analyzed retrospectively. The ＂ compression＂ mode refers to the length of LVIS stent to be shorter for more than 5 mm than the label release value by operation. The ＂ lantern＂ mode refers to the widened diameter of LVIS stent at the neck of aneurysm. The metal coverage rate in the posterior communicating segment of internal carotid artery after stent compression was calculated,and its safety and efficacy were assessed immediately after procedure and at 3 months after procedure.Results（ 1） Using LVIS stent-assisted treatment,16 wide-necked aneurysms were treated,including 8posterior communicating aneurysms,6 ophthalmic aneurysms,one anterior choroidal artery aneurysm and one M2 bifurcation fusiform aneurysm. The aneurysm neck was 1. 8 to 8. 0 mm（ mean 3. 9 ± 1. 7 mm）. A total of15 LVIS stents were implanted（ one patient with 2 aneurysms were treated with 1 stent）. All the stents were released by using ＂ compression＂ mode,and 4 of the patients（ 4 stents） also used the ＂ lantern＂ mode at the same time.（ 2） After LVIS stenting,the Raymond grade Ⅰ embolization was in 10 aneurysms（ 62. 5%）,the covered branch arteries were patent immediately after procedure.（ 3） No perioperative technology-related hemorrhagic and ischemic complications occurred. The success rate of stent implantation was 100 %（ 15 /15）.（ 4） The metal coverage rate after stent compression in the internal carotid artery posterior communicating segment was 30. 3 %-38. 5 %（ mean 35. 0 ± 2. 8 %）.（ 5） After LVIS stent implantation,15 patients were followed u

关 键 词：颅内动脉瘤 LVIS支架 颅内宽颈动脉瘤 推拉释放技术 

分 类 号：R651.12[医药卫生—外科学]