两种支架在颅内宽颈动脉瘤栓塞术中的应用比较  

A comparative study of two self-expanding stents for embolization of intracranial wide neck aneurysms

作　　者：尹剑[1] 张松 吕庆平[1] 陈怀 金许洪[1] 段传志[2] Yin Jian;Zhang Song;Lv Qingping;Chen Huai;Jin Xuhong;Duan Chuanzhi(Department of Neurosurgery, Red Cross Hospital of Hangzhou, Hangzhou, Zhejiang 310003, China;Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, China)

机构地区：[1]杭州市红十字会医院神经外科,310003 [2]南方医科大学珠江医院神经外科,广州510280

出　　处：《中国微侵袭神经外科杂志》2017年第10期440-443,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：杭州市科学技术委员会资助项目(编号:20150633B28)

摘　　要：目的比较两种支架辅助下栓塞颅内宽颈动脉瘤的安全性和有效性。方法回顾性分析54例共62个宽颈动脉瘤病人的临床资料,采用经颅内支架半释放或后释放技术辅助下弹簧圈栓塞治疗。其中采用Enterprise支架29例(Enterprise组),采用Solitaire支架25例(Solitaire组)。比较两组动脉瘤栓塞情况以及围手术期并发症等情况。结果本组54例病例共植入70枚颅内支架,其中Enterprise支架38枚,Solitaire支架32枚。所有支架成功释放,两组颅内动脉瘤栓塞效果差异无统计学意义(Z=-0.016,P=0.988)。围手术期并发症:Enterprise组5例,Solitaire组3例。两组总并发症的发生率差异无统计学意义(χ2=0.194,P=0.907)。出院时改良Rankin(m RS)评分:0分26例,1分16例,2分8例,3分4例。两组出院m RS评分差异无统计学意义(Z=-0.299,P=0.765)。随访2~36个月,所有病人恢复良好,未见再次颅内出血或新发脑梗死灶。结论两种颅内支架辅助下栓塞颅内宽颈动脉瘤技术可操作性强,安全性高,应根据载瘤动脉形态与动脉瘤颈特点,合理选用支架类型。Objective To compare the safety and efficacy of two different intracranial stents in coil embolization for the intracranial wide neck aneurysms. Methods Clinical data of 54 patients with 62 wide-neck aneurysms were analyzed retrospectively, who received intracranial stent semi-deploying or post-deploying technique-assisted coil embolization. Twenty-nine patients were treated with Enterprise stents as Enterprise group and 25 with Solitaire stents as Solitaire group. The intraoperative embolization and perioperative complications were analyzed and compared between the two groups. Results There were 70 stents implanted including 38 Enterprise stents and 32 Solitaire stents. All the stents were deployed successfully. There was no significant difference in embolization outcome between two groups（Z =-0.016, P = 0.988）. Perioperative complications occurred in 5 patients in Enterprise group and 3 in Solitaire group. There were no significant differences in the incidence of perioperative complications between the two groups（χ2= 0.194, P =0.907）. The modified Rankin scale（m RS） score were 0 in 26 patients, 1 in 16, 2 in 8 and 3 in 4 at discharge. There were no significant differences in m RS scores between the two groups（Z =-0.299, P = 0.765）. All the patients recovered well after the follow-up period of2 to 36 months and no rebleeding or new infarction occurred. Conclusions For intracranial wide neck aneurysms, Enterprise and Solitaire stent-assisted coil embolization has high technical operability and safety. The stent might be chosen properly according to morphology of parent artery and characteristics of aneurysmal neck.

关 键 词：颅内动脉瘤 宽颈 支架 颅内 栓塞 弹簧圈 

分 类 号：R651.12[医药卫生—外科学]