Enterprise多支架重叠技术在未破裂椎动脉夹层动脉瘤中的应用  

Application of multiple Enterprise stent overlapping technique in the embolization of unruptured vertebral dissecting aneurysms

作　　者：纪文军[1] 康慧斌[1] 孙立倩[1] 刘爱华[1] 姜除寒[1] 杨新健[1] 李佑祥[1] 吴中学[1] 

机构地区：[1]北京市神经外科研究所,首都医科大学附属北京天坛医院神经介入科,100050

出　　处：《中国微侵袭神经外科杂志》2016年第3期97-100,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都卫生发展科研专项(编号:2014-3-2044,2011-1015-04);国家自然科学基金(编号:81441038,81371314);北京自然科学基金(编号:7142032)

摘　　要：目的探讨Enterprise多支架重叠技术在未破裂椎动脉夹层动脉瘤治疗中的应用。方法回顾性分析35例病人共38枚未破裂椎动脉夹层动脉瘤的临床资料,其中Ⅰ型和Ⅱ型椎动脉夹层动脉瘤33个,运用Enterprise多支架辅助弹簧圈栓塞;Ⅲ型5个,行单纯多支架植入。术后进行临床和影像学随访。结果术后即刻造影结果：动脉瘤完全栓塞5个,部分栓塞28个,无变化5个。操作相关并发症3例,其中支架移位2例,穿刺点假性动脉瘤形成1例;缺血性并发症3例,其中枕叶梗死1例,脑干梗死1例,脑干缺血1例;无出血性并发症。术后6-12个月行DSA随访,动脉瘤完全栓塞23个,部分栓塞14个,无变化1个。33个Ⅰ型和Ⅱ型椎动脉夹层动脉瘤,影像学随访的栓塞有效率为100%;5个Ⅲ型椎动脉夹层动脉瘤,栓塞有效率为80%。临床随访8-30个月,m RS评分0分30例,1分5例;随访过程中无新发神经功能障碍。结论 Enterprise多支架重叠技术治疗未破裂椎动脉夹层动脉瘤是安全和有效的。Objective To investigate the application of multiple Enterprise stent overlapping technique in embolization of unruptured vertebral dissecting aneurysm（VDA）. Methods Clinical data of 35 patients with 38 unruptured VDAs treated by multiple Enterprise stent overlapping technique were analyzed retrospectively. Of all, 33 type Ⅰ and Ⅱ VDAs underwent multiple Enterprise stent-assisted coiling, and 5 type Ⅲ VDAs underwent multiple Enterprise stent implanting alone. The clinical and imaging follow-up studies were performed in all the patients. Results Instant angiographic results： complete occlusion was achieved in 5 VDAs, partial occlusion in 28 and no change in 5. Procedure-related complications occurred in 3 patients, including stents migration in 2 patients and pseudo-aneurysm at puncture site in 1. Ischemic events occurred in 3 patients, including occipital infarction in 1 patient, brain stem infarction in 1 and ischemic attack of brain stem in 1. However, no hemorrhagic events occurred. DSA follow-up was performed in all the patients during 6to 12 months after the operation, complete occlusion was achieved in 23 VDAs, partial occlusion in 14 and no change in 1. For 33 VDAs with type Ⅰ or Ⅱ, the rate of effective embolization was 100%. For 5 VDAs with type Ⅲ, the rate of effective embolization was 80%.Clinical follow-up was performed for 8 to 30 months, and the m RS score was 0 in 30 patients and 1 in 5. There was no newly occurred neurological dysfunction during follow-up period. Conclusion Multiple Enterprise stents overlapping technique is safe and effective for embolization of unruptured VDA.

关 键 词：动脉瘤 夹层 椎动脉 栓塞 治疗性 支架植入 

分 类 号：R651.12[医药卫生—外科学]