Neuroform Atlas在双支架技术治疗复杂颅内分叉部宽颈动脉瘤中的应用  

Application of Neuroform Atlas in dual stent-assisted coiling for the treatment of complex intracranial wide-neck bifurcation aneurysms

作　　者：韩金涛[1] 李选[1] 贾子昌[1] 栾景源[1] 梁飞 张宇翔 赵世录 赵彦清 HAN Jintao;LI Xuan;JIA Zichang;LUAN Jingyuan;LIANG Fei;ZHANG Yuxiang;ZHAO Shilu;ZHAO Yanqing(Department of Interventional Radiology and Vascular Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《介入放射学杂志》2023年第3期215-218,共4页Journal of Interventional Radiology

摘　　要：目的 探讨Neuroform Atlas支架在双支架技术辅助弹簧圈栓塞治疗复杂颅内分叉部宽颈动脉瘤(wide-neck bifurcation aneurysm,WNBA)的安全性和有效性。方法 回顾性分析我院2020年12月到2022年5月采用Neuroform Atlas支架以双支架辅助栓塞(dual stent-assisted coiling,DSAC)治疗的19例复杂WNBA患者临床资料。19例患者共19个WNBA,其中5个为破裂性动脉瘤。分布部位:10个位于大脑中动脉M1分叉处、7个位于前交通动脉、2个位于基底动脉尖。其中18个动脉瘤采取“Y”型DSAC、1个采取“X”型DSAC技术治疗。栓塞后复查脑血管数字减影血管造影(digital subtraction angiography,DSA),采取Raymond量表评估即刻栓塞效果和载瘤动脉情况。临床随访采用改良Rankin评分量表(modified Rankin Scale,mRS)评估患者术后3个月临床预后,影像学随访采取复查全脑血管DSA,评估患者术后6个月时动脉瘤闭塞情况和载瘤动脉通畅情况。结果 19例患者手术步骤均成功,技术成功率为100%。DSAC后复查DSA显示动脉瘤即刻闭塞情况:16个为RaymondⅠ级(完全闭塞)、2个为RaymondⅡ级(瘤颈残留)、1个为RaymondⅢ级(瘤体残留)。1例患者出现围手术期并发症:为分支动脉内血栓形成,予替罗非班治疗后血流恢复,苏醒后无明显神经功能缺失。术后3个月时18例患者获临床随访,均预后良好(m RS≤2分)。术后6个月时16例患者获DSA影像随访:RaymondⅠ级14个、RaymondⅡ级1个、RaymondⅢ级1个。结论 Neuroform Atlas支架用于DSAC治疗WNBA技术成功率较高,有较低的围手术期并发症发生率和较高的动脉瘤闭塞率,较传统支架有一定优势,但其远期疗效还需进一步随访观察。Objective To assess the safety and efficacy of dual stent-assisted coiling(DSAC)with Neuroform Atlas stents in the treatment of complex intracranial wide-neck bifurcation aneurysms(WNBA).Methods The clinical data of 19 patients with complex intracranial WNBA,who received DSAC with Neuroform Atlas stents at Peking University Third Hospital of China between December 2020 and May 2022,were retrospectively analyzed.A total of 19 WNBAs were detected in the 19 patients,of which 5 were ruptured aneurysms.The aneurysms located at the bifurcation of Ml segment(n=10),at the anterior communicating artery(n=7),and at the apex of basilar artery(n=2).Y-shaped DSAC was employed for 18 aneurysms and X-shaped DSAC was adopted for one aneurysm.Immediately afer DSAC procedure,digital subtraction angiography(DSA)reexamination was performed,and Raymond Scale was used to assess the occlusion extent of the aneurysm and the patency status of the parent artery.During follow-up period,modified Rankin Scale(mRS)was used to evaluate postoperative 3-month clinical outcome.Follow-up check with whole-cerebral DSA was performed to evaluate the postoperative 6-month status of the aneurysm occlusion extent and the parent artery patency.Results Successful DSAC procedure was accomplished in allthe 19 patients,the technical success rate was 100%.DSA performed immediately after DSAC procedure showed that 16 aneurysms achieved Raymond grade Ⅰ(complete embolization),2 aneurysms achieved Raymond grade Ⅱ(residue of aneurysm neck),and one aneurysm achieved Raymond grade Ⅲ(residue of aneurysm cavity).One patient developed perioperative complication of thrombosis in the branch arteries,the blood flow recovered after tirofiban treatment and no significant neurological function damage was observed after the patient woke up.Eighteen patients were clinically fllowed up at 3 months after DSAC,and all of them obtained good prognosis(mRS≤2 points).Sixteen patients were followed up with DSA at 6 months after DSAC,which showed that Raymond grade Ⅰ was obta

关 键 词：分叉部宽颈动脉瘤 双支架辅助栓塞 Neuroform Atlas支架 

分 类 号：R743[医药卫生—神经病学与精神病学]