LVIS支架辅助弹簧圈栓塞大脑中动脉M1段累及分支囊状动脉瘤的疗效评价  

Efficacy evaluation of LVIS stent assisted coils for the m iddle cerebral artery M1 segment involving branches saccular aneurysms

作　　者：李锦 戴冬伟[1] 黄清海[1] 许奕[1] 刘建民[1] 洪波[1] Li Jin;Dai Dongwei;Huang Qinghai;Xu Yi;Liu Jianmin;Hong Bo(Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433

出　　处：《中国脑血管病杂志》2018年第9期478-482,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项资助项目(2016YFC1300700);国家卫生计生委脑卒中防治工程"中国脑卒中高危人群干预适宜技术研究及推广项目"(GN-2016R0012)

摘　　要：目的探讨使用LVIS支架辅助弹簧圈栓塞大脑中动脉M1段累及分支动脉囊状动脉瘤的安全性及有效性。方法回顾性连续纳入2014年5月至2017年12月在第二军医大学附属长海医院采用LVIS支架辅助弹簧圈治疗的16例大脑中动脉M1段累及分支动脉的囊状动脉瘤患者的临床资料,分析其影像学特点、手术相关并发症、术后即刻结果及其随访结果。结果 16例患者中,破裂动脉瘤3例,未破裂动脉瘤13例,均为宽颈动脉瘤且瘤颈或瘤体累及分支动脉。(1)即刻栓塞结果:Raymond分级Ⅰ级4例,Ⅱ级5例,Ⅲ级7例。支架置入后载瘤动脉均保持通畅。其中1例发生缺血并发症,原因为术中支架内急性血栓形成。(2)13例患者获得影像学随访[4～24个月,中位数6.0(5.5,8.5)个月],其中10例达到完全栓塞,1例进一步血栓形成,1例保持稳定,1例瘤颈少量复发。(3)15例患者获得临床随访[4～36个月,中位数19(12,24)个月],改良Rankin量表评分均为0～1分,无一例患者出现新的神经功能障碍或死亡。结论 LVIS支架治疗大脑中动脉M1段累及分支动脉的囊状动脉瘤安全、有效,但仍需要更大样本研究和长期随访结果进一步验证。Objective To investigate the safety and effectiveness of using LVIS stent-assisted coils embolization of middle cerebral artery M1 segment involving branched saccular aneurysms. Methods From May 2014 to December 2017,the clinical data of 16 consecutive patients with saccular aneurysms involving the branch arteries in the M1 segment of the middle cerebral artery treated with LVIS stent-assisted coils in Changhai Hospital,the Second Military Medical University were enrolled retrospectively. Their imaging features,surgical-related complications,immediate postoperative results,and follow-up results were analyzed.Results Of the 16 patients,3 had ruptured aneurysms and 13 had unruptured aneurysms,they were all wide-necked aneurysms with the neck or body involving the branch arteries.（ 1） Immediate embolization results： Raymond grade ofⅠwas in 4 cases,Ⅱin 5 cases,and Ⅲ in 7 cases. After stenting,all the parent arteries were patent. One of them developed ischemic complication due to in-stent acute thrombosis.（ 2） Thirteen patients were imaging followed up for 4-24 months,a median of 6. 0（ 5. 5,8. 5） months,in which 10 were embolized completely,1 had further thrombosis,1 remained stable,and 1 had a small amount of aneurysm neck recurrence.（ 3） The clinical follow-up time of 15 patients was 4-36 months,a median19（ 12,24）months. The mRS score was 0-1. None of the patients developed new neurological dysfunction or death. Conclusion LVIS stenting is safe and effective in the treatment of cystic aneurysms of the middle cerebral artery M1 segment involving of branches,but it still needs to be further validated by larger sample studies and long-term follow-up results.

关 键 词：颅内动脉瘤 大脑中动脉分支动脉 LIVS支架 

分 类 号：R743[医药卫生—神经病学与精神病学]