Willis覆膜支架治疗复杂颈内动脉病变的临床应用  

Clinical application of Willis covered stent implantation in treating complex internal carotid artery lesions

作　　者：马金阳[1] 汪雷[1] 董元训[1] 胡火军[1] 黄松[1] 符常涛 MA Jinyang;WANG Lei;DONG Yuanxun;HU Huojun;HUANG Song;FU Changtao(Institute of Neurology,China Three Gorges University,Department of Neurosurgery,Yichang Municipal Central People’s Hospital,Yichang,Hubei Province 443003,China)

机构地区：[1]三峡大学神经病学研究所/宜昌市中心人民医院神经外科,湖北宜昌443003

出　　处：《介入放射学杂志》2022年第12期1185-1189,共5页Journal of Interventional Radiology

基　　金：湖北省宜昌市医疗卫生科研项目(A18-301-29)。

摘　　要：目的评价Willis覆膜支架治疗复杂颈内动脉病变中的可行性、安全性和有效性。方法回顾性分析2015年7月至2021年1月宜昌市中心人民医院采用Willis覆膜支架治疗的18例复杂颈内动脉病变患者临床资料。入院后均经脑血管DSA造影明确诊断,术前准备完成后行覆膜支架植入术。术后进行临床和DSA或CTA影像随访,改良Rankin量表(mRS)评分评估疗效。结果18例患者中有6例未破裂囊状宽颈大动脉瘤,5例破裂的血泡样动脉瘤,6例颈内动脉海绵窦瘘,1例外伤性假性动脉瘤。共成功植入Willis覆膜支架19枚。13例患者支架释放后即刻造影显示病变消失;5例出现内漏,其中4例球囊扩张后内漏消失,病变封闭良好,1例出现支架塌陷,再植入1枚支架后病变消失。未发生手术操作相关并发症。随访3~18个月,所有患者无新发神经功能障碍,DSA或CTA复查显示病变完全消失,载瘤动脉通畅,无复发。1例术后6个月发生支架内狭窄,二次复查后狭窄好转。mRS评分0分17例,1分1例。结论初步结果表明,Willis覆膜支架治疗复杂颈内动脉病变可行、安全,近中期疗效良好。Objective To evaluate the feasibility,safety and effectiveness of Willis covered stent implantation in treating complex internal carotid artery lesions.Methods The clinical data of 18 patients with complex internal carotid artery lesions,who were admitted to the Yichang Municipal Central People’s Hospital of China between July 2015 and January 2021 to receive Willis covered stent implantation,were retrospectively analyzed.After admission,the diagnosis was confirmed by cerebrovascular angiography with DSA,and after completing the preoperative preparation the implantation of Willis covered stent was carried out.All patients were followed up through clinical visit and DSA or CTA imaging reexamination.Modified Rankin scale(mRS)score was used to assess the efficacy.Results Of the 18 patients,unruptured large wide-necked saccular aneurysm was detected in 6,ruptured blood blister-like aneurysm in 5,internal carotid cavernous sinus fistula in 6,and traumatic pseudoaneurysm in one.A total of 19 Willis covered stents were successfully implanted in the 18 patients.After stent was released,the instant angiography showed that the lesion disappeared in 13 patients;endoleak was observed in 5 patients,in 4 of them the endoleak disappeared after balloon dilation and the leak site was well sealed;and in one patient stent collapse occurred,and the lesion disappeared after implantation of one additional stent.No surgical procedure-related complications occurred.The patients were followed up for 3-18 months,and no newly-developed neurological dysfunction was observed.DSA or CTA imaging reexamination revealed that the lesion was completely resolved and the parent artery was patent with no recurrence.One patient developed in-stent stenosis at 6 months after surgery,a second reexamination showed that the stenosis degree was improved.The mRS score of 0 point was seen in 17patients,and mRS score of one point was seen in one patient.Conclusion The preliminary results of this study indicate that in treating complex internal carotid artery

关 键 词：Willis覆膜支架 复杂颈内动脉病变 血管内治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]