颅内宽颈动脉瘤破裂急性期LVIS支架辅助弹簧圈栓塞治疗  

LVIS stent-assisted coil embolization in treating ruptured wide-necked intracranial aneurysms in the acute stage

作　　者：刘珍[1] 王辉[1] 肖仕和 李钢[1] LIU Zhen;WANG Hui;XIAO Shi-He;LI Gang(Department of Neurosurgery,The Third People's Hospital of Hainan Province,SanYa,572000,China)

机构地区：[1]三亚中心医院(海南省第三人民医院)神经外科,海南三亚572000

出　　处：《国际神经病学神经外科学杂志》2020年第3期239-243,共5页Journal of International Neurology and Neurosurgery

基　　金：2014年三亚市医疗卫生科技创新项目(2014YW40)。

摘　　要：目的探讨颅内宽颈动脉瘤破裂出血急性期应用LVIS支架辅助弹簧圈栓塞治疗的策略。方法回顾2017年1月—2019年12月应用LVIS支架辅助弹簧圈栓塞的17例颅内宽颈动脉瘤破裂(共19个动脉瘤)患者资料。栓塞术前阿司匹林和氯吡格雷各300mg口服或肛门给药,术中常规体内肝素化。采用Raymond分级标准评价栓塞效果。术后口服阿司匹林(100 mg/日,持续6个月),氯吡格雷(75 mg/d,持续3个月)。临床治疗效果评估采用改良Rankin量表(modified Rankin Scale,mRS),0~2级属预后良好。结果17例患者支架均完全释放,技术成功率100%。栓塞后即刻造影均显示完全填塞。在栓塞治疗中有2例(11.8%)患者发生颅内血管栓塞,经微导管注入替罗非班5~10 m L后血管再通。1例术后因呼吸衰竭而死亡。1例术后因急性心梗死亡。存活患者预后mRS 0分5例,1分3例,2分6例,3分1例。预后良好率88.2%。无支架相关不良事件发生。结论LVIS支架辅助弹簧圈栓塞急性期破裂宽颈动脉瘤可获得良好的栓塞效果,但围手术期风险及远期疗效有待于进一步大样本随访研究。Objective To explore the strategy of LVIS stent-assisted coil embolization in treating ruptured wide-necked intracranial aneurysms in the acute stage.Methods A retrospective analysis was performed on the clinical data of 17 patients with ruptured widenecked intracranial aneurysms(a total of 19 aneurysms)who were treated with LVIS stent-assisted coil embolization from January 2017 to December 2019.Before the operation,all patients received oral or rectal administration of aspirin and clopidogrel,each at a dose of300 mg.During the operation,conventional heparinization was performed.The Raymond classification was used to assess the effectiveness of embolization.After the operation,all patients received oral administration of aspirin(100 mg/d for 6 months)and clopidogrel(75 mg/d for 3 months).The modified Rankin Scale(mRS)was used to evaluate the clinical efficacy,and grade 0~2 represented a good prognosis.Results In this group of patients,17 stents were completely released,with a success rate of 100%.The angiography immediately after embolization showed that all the aneurysms were completely occluded.Two patients(11.8%)developed intracranial vascular embolism during the embolization therapy.After 5~10 m L of tirofiban injection,the vessels were recanalized.After the operation,one patient died of respiratory failure,and another died of acute myocardial infarction.Among the surviving patients,the prognostic mRS score was as follows:0 in 5 cases,1 in 3 cases,2 in 6 cases,and 3 in 1 case,with a good prognosis rate of 88.2%.No stent-related adverse events occurred.Conclusions LVIS stent-assisted coil embolization has a good effect in treating ruptured widenecked aneurysms in the acute stage,but its risk and long-term efficacy still need large-sample studies and follow-up.

关 键 词：LVIS支架 颅内宽颈动脉瘤 栓塞 

分 类 号：R743.34[医药卫生—神经病学与精神病学]