LVIS支架灯笼技术辅助栓塞伴胚胎型大脑后动脉破裂后交通动脉宽颈动脉瘤的疗效观察  

Efficacy of LVIS stent lantern technique assisted embolization for ruptured wide-necked posterior communicating artery aneurysms with fetal-type posterior cerebral artery

作　　者：史岩[1] 刘亮[1] 刘振[1] 崔斯童 陈骅[2] Shi Yan;Liu Liang;Liu Zhen;Cui Sitong;Chen Hua(Department of Neurosurgery,Nanjing First Hospital,Nanjing Medical University,Nanjing 210000,China;Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属南京医院神经外科,南京210000 [2]南京医科大学第一附属医院神经外科,南京210029

出　　处：《中华神经外科杂志》2023年第7期674-678,共5页Chinese Journal of Neurosurgery

基　　金：江苏省卫生健康委医学科研项目(M2022006)。

摘　　要：目的观察LVIS支架"灯笼"技术辅助弹簧圈栓塞伴有胚胎型大脑后动脉(fPCA)的破裂后交通动脉(PCoA)宽颈动脉瘤的疗效。方法回顾性连续纳入2015年1月至2020年1月南京医科大学附属南京医院神经外科采用LVIS支架"灯笼"技术辅助弹簧圈栓塞的伴有fPCA的破裂PCoA宽颈动脉瘤患者,共24例。采用Raymond分级标准评估动脉瘤的栓塞情况,采用改良Rankin量表评分(mRS)评估临床预后,0~2分为预后良好,3~6分为预后不良。结果24例患者均成功栓塞动脉瘤。围手术期2例发生短暂性脑缺血发作。术后即刻数字减影血管造影(DSA)显示,Raymond分级Ⅰ级栓塞(完全栓塞)16例,Ⅱ级栓塞(次全栓塞)4例,Ⅲ级栓塞(不完全栓塞)4例,PCoA均通畅。20例患者获得临床随访,随访时间为(58.0±9.2)个月(25~79个月),其中mRS 0分19例,1分1例。19例患者行影像学随访,中位随访时间为52个月(3~65个月),其中Raymond分级Ⅰ级栓塞17例,Ⅱ级栓塞2例(其中1例为复发患者);支架内重度狭窄伴PCoA闭塞1例。结论LVIS支架"灯笼"技术辅助弹簧圈栓塞伴有fPCA的破裂PCoA宽颈动脉瘤安全,临床疗效好。Objective To investigate the effectiveness of lantern technique using braided stent(LVIS)in performing coil embolization for ruptured wide-necked posterior communicating artery(PCoA)aneurysms combined with fetal-type posterior cerebral artery(fPCA).Methods A retrospective analysis was conducted on the clinical data of 24 consecutive patients with ruptured wide-necked PCoA aneurysms combined with fPCA who underwent the lantern technique by using LVIS at the Department of Neurosurgery,Nanjing First Hospital,Nanjing Medical University between January 2015 to January 2020.The embolization outcome was evaluated using the Raymond grading system.The clinical outcome was assessed based on the modified Rankin scale(mRS):0-2 as favorable outcomes and 3-6 as unfavorable outcomes.Results All 24 patients underwent successful aneurysm embolization.There were 2 cases(8.3%)of perioperative transient ischemic attack.Immediate postoperative DSA showed that Raymond gradeⅠwas achieved in 16 cases,Raymond gradeⅡin 4 cases,and Raymond gradeⅢin 4 cases.The fPCA was patent in all cases.The average clinical follow-up time of 20 patients was 58.0±9.2 months(25-79 months).The mRS score was 0 in 19 cases and 1 in 1 case.The median imaging follow-up time of 19 patients was 52 months(3-65 months).Raymond gradeⅠwas achieved in 17 and Raymond gradeⅡin 2 cases.Severe in-stent stenosis with PCoA occlusion occurred in 1 case.The PCoA was patent in the remaining patients.Conclusion The lantern technique using LVIS stent showed good safety and efficacy in the treatment of ruptured wide-necked PCoA aneurysm combined with fPCA.

关 键 词：颅内动脉瘤 栓塞 治疗性 支架 后交通动脉 胚胎型大脑后动脉 灯笼技术 

分 类 号：R651.12[医药卫生—外科学]