急性破裂宽颈囊性动脉瘤经单纯弹簧圈栓塞后分期支架辅助治疗的临床效果观察  

Clinical effect of staged stent-assisted embolization after initial coiling of acute ruptured wide-neck saccular intracranial aneurysms

作　　者：辛涛 闫亚洲 潘源 贺西亮 黄清海 Xin Tao;Yan Yazhou;Pan Yuan;He Xiliang;Huang Qinghai(Department of Neurosurgery of NO.971 Hospital of PLA Navy,Qingdao,Shandong 266071,China)

机构地区：[1]解放军海军第九七一医院神经外科,青岛266071 [2]海军军医大学第一附属医院神经外科

出　　处：《中国脑血管病杂志》2019年第9期478-482,489,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划项目(2016YFC1300700)

摘　　要：目的评估急性期行单纯弹簧圈栓塞后分期支架辅助治疗破裂的宽颈囊性动脉瘤的安全性和有效性。方法回顾性连续纳入2006年11月至2017年12月解放军海军第九七一医院神经外科和海军军医大学第一附属医院神经外科收治的破裂宽颈囊性动脉瘤患者58例(58个动脉瘤),急性期行单纯弹簧圈栓塞,二期行支架置入。根据Raymond分级评价术后即刻及随访中的栓塞结果,采用改良Rankin量表评估预后。结果 58例患者(58个动脉瘤)均成功进行分期支架辅助治疗。分期治疗中位时间间隔4. 4(4.1,4.9)周。在分期支架置入治疗前,患者未发生动脉瘤再出血。支架治疗术后即刻造影示动脉瘤完全闭塞30例(51.7%),瘤颈残留22例(37.9%),瘤囊残留6例(10.3%),其中1例患者支架置入术后2 h出现支架内血栓事件,使用替罗非班后支架内再通。出院时改良Rankin量表评分0~2分46例(79.3%),3分8例(13.8%),4分4例(6.9%)。影像学随访6~35个月(中位随访时间16个月),47例动脉瘤完全闭塞(81.0%),瘤颈残留7例(12.1%),瘤囊残留4例(6.9%)。无复发病例,所有载瘤动脉保持通畅。临床随访6~36个月(中位随访时间18个月),改良Rankin量表评分0~2分50例(86.2%),3分8例(13.8%),无新发神经功能障碍或死亡。结论破裂的宽颈囊性动脉瘤急性期行单纯弹簧圈栓塞治疗后,行分期支架辅助治疗是安全和有效的。Objective To evaluate the safety and efficacy of coiling in the acute phase followed by staged stenting for ruptured wide-neck saccular intracranial aneurysms. Methods From November 2006 to December 2017,We retrospectively reviewed 58 consecutive patients with acute ruptured wide-neck saccular intracranial aneurysms(58 ruptured wide-neck saccular intracranial aneurysms) who were treated with staged stent-assisted embolization after initial coiling in the Department of Neurosurgery of NO.971 Hospital of PLA Navy and the Department of Neurosurgery of First Hospital Affiliated to Naval Medical University . Simple coiling embolization was performed in the acute phase,and stent implantation was performed in the second stage.The immediate postoperative and follow-up angiographic results were assessed using the Raymond scale,and the outcome of clinical follow-up was assessed using the modified Rankin Scale(mRS). Results All 58 patients(58 ruptured wide-neck saccular intracranial aneurysms) were successfully treated with staged stent-assisted embolization.The median interval of staged stenting treatment was 4.4(4.1,4.9) weeks.No aneurysm rebleeding occurred prior to the staged stenting treatment.During the treatment of staged stenting,coils were used as many as possible for embolization under the mechanical protection of stents in order to achieve complete occlusion.Immediately after stenting, angiography showed 30 aneurysms (51.7%) with complete occlusion,22 aneurysms (37.9%) with neck remnant and 6 aneurysms(10.3%) with residual sac.One patient suffered in-stent thrombosis two hours after stent implantation,which was relieved with the use of tirofiban.When discharging hospital,showing that a total of 46 patients (79.3%) had mRS 0 - 2, 8 patients(13.8%) had mRS 3 and 4 patients(6.9%) had mRS 4.Imaging follow-up ranged 6 - 35 months(median 16 months),showing 47 aneurysms(81.0%) with complete occlusion,7 aneurysms(12.1%) with residual neck and 4 aneurysms(6.9%) with residual sac.There was no recurrence ,and the parent art

关 键 词：颅内动脉瘤 支架 动脉瘤破裂 血管内治疗 单纯弹簧圈栓塞 分期治疗 

分 类 号：R651.12[医药卫生—外科学]