Navien导管在颅内动脉瘤栓塞术中的应用  

Application of Navien catheter in intracranial aneurysm embolization

作　　者：吴德刚[1] 李真保[1] 赵心同[1] 赖年升[1] 刘佳强[1] 盛斌[1] 袁金龙[1] 方兴根[1] 

机构地区：[1]皖南医学院附属弋矶山医院神经外科,安徽省芜湖市241001

出　　处：《中国脑血管病杂志》2017年第3期133-138,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨Navien导管在颅内动脉瘤栓塞术中的使用技术及效果。方法回顾性分析皖南医学院附属弋矶山医院神经外科于2016年3月至12月血管内治疗颅内动脉瘤中使用Navien导管的15例患者资料。所有患者颈内动脉颅外段严重迂曲,术中均使用同轴系统,观察Navien导管能否顺利到达目标血管位置,并运用单纯弹簧圈或支架辅助弹簧圈栓塞治疗相应部位颅内动脉瘤,即刻栓塞结果按Raymond分级评价,观察术中和术后并发症并进行影像学随访。结果 15例患者均为颈内动脉颅外段异常迂曲,Navien导管能顺利通过弯曲血管并能到达目标位置,对9例患者采用支架辅助弹簧圈栓塞,6例患者采用单纯弹簧圈栓塞,弹簧圈和支架的置入技术成功率100%,支架均准确释放到位,无移位。动脉瘤即刻栓塞Raymond分级显示,RaymondⅠ级15例。术中1例出现颈内动脉痉挛,予以罂粟碱后好转,其余无术中脑血管痉挛、血管夹层、支架内血栓形成以及术中动脉瘤破裂等并发症。术后对5例进行DSA随访3~6个月,动脉瘤未见复发、支架无狭窄及移位,无再出血和脑缺血。结论对于存在颈内动脉颅外段严重迂曲的患者,使用Navien导管能克服动脉迂曲等不利因素,顺利到达目标血管位置,使得颅内动脉瘤的栓塞治疗顺利完成。Objective To investigate the application technology and effect of Navien catheter in intracranial aneurysms embolization. Methods The clinical data of 15 patients with intracranial aneurysm treated with Navien catheter in Department of Neurosurgery of Yijishan Hospital Affiliated to Wannan Medical College from March to December 2016 were analyzed retrospectively. The extracranial segments of internal carotid arteries were seriously tortuous in all patients. The coaxial system was used during procedure. Whether the Navien catheter could be smoothly placed into the target artery or not was observed,and the coils or stent-assisted coils were used to embolize the intracranial aneurysms in the correspondiog positions. The immediate embolization resuhs were assessed by the Raymond grading. The intraoperative and postoperative complications were observed and the patients were followed up by imaging. Results All 15 patients had abnormal tortuosity of extracranial segments of internal carotid arteries. The Navien catheter was able to smoothly pass through the tortuous vessels and reach the desired position. The stent-assisted coil embolization was used in 9 patients, and the coil embolization was used in 6 patients. The success rate of the coil and stent placement technology was 100%. The stents were all accurately put in place without shift. According to the Raymond grading, the immediate embolization rate of aneurysms showed that 15 patients achieved Raymond grade I ~ One case developed internal carotid spasm during the procedure. The patient was improved after giving papaverine. Others did not have intraoperative complications, such as cerebral vasospasm, vascular dissection,in-stent thrombosis, and intraoperative aneurysm rupture. Five patients were followed up for 3 to 6 months with digital subtraction angiography （DSA）. There was no recurrence of aneurysm and no in-stent stenosis and shift,No rebleeding or cerebral ischemia was observed. Conclusion For patients with severely tortuous in extracranial segments of

关 键 词：颅内动脉瘤 血管内治疗 血管迂曲 Navien导管 

分 类 号：R651.12[医药卫生—外科学]