LVIS支架辅助栓塞破裂的BBA的有效性和安全性  

Analysis of Efficacy and Safety of LVIS Stent in Treatment of Ruptured Internal Carotid Artery’s Blood Blister-like Aneurysms

作　　者：岑键昌[1] 高鸿[1] 刘博虎 吴钧[1] 钱晓敏 王京 苏平[1] CEN Jian-chang;GAO Hong;LIU Bo-hu;WU Jun;QIAN Xiaomin;WANG Jing;SU Ping(Dept.of Neurosurgery,The 1st People’s Hospital of Kunming City,Kunming Yunnan 650034,China)

机构地区：[1]昆明市第一人民医院神经外科,云南昆明650034

出　　处：《昆明医科大学学报》2020年第6期109-114,共6页Journal of Kunming Medical University

基　　金：云南省医疗卫生单位内设研究机构科研资助项目(2017NS086)。

摘　　要：目的分析15例使用LVIS支架辅助弹簧圈栓塞治疗的颈内动脉破裂的血泡样动脉瘤患者的有效性和安全性。方法 15例患者均使用LVIS支架辅助弹簧圈栓塞治疗,其中5例患者行双支架辅助栓塞治疗,分析术中动脉瘤破裂出血、术中血栓形成、术中及术后载瘤动脉分支血管闭塞、支架释放后移位、支架释放后塌陷、弹簧圈逃逸发生率及手术结束前、术后14 d、90 d的Raymond分级、MRS评分。结果 15例患者均行支架辅助弹簧圈栓塞,弹簧圈使用率为100%,共5例采取双支架辅助栓塞,其中3例为双LVIS支架,一例为LVIS支架+Enterprise支架,另一例为Solitaire AB支架+LVIS支架。术中动脉瘤破裂出血一例,手术结束时评估,Raymond分级1级14例(93.3%) 0,Raymond分级2级1例(6.7%)。术后14d造影复查再评估,14例患者为Raymond分级1级(93.3%),1例患者为Raymond分级2级(6.7%);14例患者m RS评分0分(93.3%),1例患者m RS评分2分(6.7%)。术后90 d造影复查再评估,15例患者全部为Raymond分级1级(100%),无复发患者;14例患者m RS评分0分(93.3%),1例患者m RS评分1分(6.7%)。结论 LVIS支架辅助栓塞破裂的颈内动脉血泡样动脉瘤具有一定的有效性和安全性,远期疗效仍需多中心、大样本及长时间的随访观察。Objective To analyze the efficacy and safety of LVIS stent assisted coil embolization in 15 patients with ruptured internal carotid artery's blood blister-like aneurysms.Method All 15 cases received LVIS stent assisted coil embolization,among which 5 cases received dual stents.Intraoperative aneurysm rupture and hemorrhage,intraoperative thrombosis,intraoperative and postoperative occlusion of parent artery branches,displacement after stent release,collapse after stent release,and incidence of spring coil escape were analyzed.Raymond grading and MRS score were made before surgery,14 days and 90 days after surgery.Results All 15 patients received stent assisted coil embolization,and the utilization rate of coil was 100%.A total of 5 patients received dual stents assisted embolization,3 patients received dual LVIS stents,one patient received LVIS+Enterprise stents,and the other patient received Solitire AB+LVIS stents.There was 1 case of intraoperative aneurysm rupture and hemorrhage.At the end of the operation,14 cases(93.3%)were rated as grade 1 by Raymond,while 1 case(6.7%)was rated as grade 2 by Raymond.The same results were found 14 days after the operation.MRS score of 14 patients was 0(93.3%)and mRS score of 1 patient was 2(6.7%).At 90 days after surgery,all the 15 patients were rated at Raymond grade 1(100%)and no recurrence was found.MRS score of 14 patients was 0(93.3%)and MRS score of 1 patient was 1(6.7%).Conclusions The efficacy and safety of LVIS stent-assisted embolization of ruptured internal carotid artery's blood blister-like aneurysms cound be proved.However,its long term efficacy requires evaluation from large sample sizesin more centers,and long-term follow-ups.

关 键 词：颈内动脉 血泡样动脉瘤 LVIS支架 

分 类 号：R651.1[医药卫生—外科学]