支架"摆尾"技术辅助栓塞伴有胚胎型大脑后动脉的后交通动脉宽颈动脉瘤的初步观察  

Preliminary observation of the swinging-tail technique in assisting embolization of wide-neck aneurysms of the posterior communicating artery with fetal-type posterior cerebral artery

作　　者：韩凯昊[1] 郭新宾[1] 刘烁 陈振[1] 权涛[1] 范锋[1] 徐浩文[1] 管生[1] Han Kaihao;Guo Xinbin;Liu Shuo;Chen Zhen;Quan Tao;Fan Feng;Xu Haowen;Guan Sheng(Department of Neurointerventional Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]郑州大学第一附属医院神经介入科,郑州450002

出　　处：《中华神经外科杂志》2024年第8期791-796,共6页Chinese Journal of Neurosurgery

摘　　要：目的初步观察支架"摆尾"技术辅助弹簧圈栓塞伴有胚胎型大脑后动脉(fPCA)的后交通动脉(PCoA)宽颈动脉瘤的安全性和有效性。方法回顾性分析2018年8月至2023年8月郑州大学第一附属医院神经介入科采用支架"摆尾"技术辅助弹簧圈栓塞伴有fPCA的PCoA宽颈动脉瘤的14例患者的临床资料。观察是否达到技术成功以及操作相关并发症的情况。术后6个月进行电话或门诊随访并择期复查全脑数字减影血管造影(DSA)。神经功能状态以改良Rankin量表评分(mRS)评价,动脉瘤的栓塞效果以Raymond分级评价。结果14例患者全部获得技术成功,均未出现操作相关并发症。1例患者术后16 d因呼吸衰竭死亡;另13例患者中,出院时mRS 0分11例,1分1例,2分1例。术后6个月随访时,13例患者的mRS均为0分。11例患者完成DSA随访,随访时间[M(Q_(1),Q_(3))]为7(5,10)个月;结果显示,PCoA均开放良好,未出现支架内狭窄,其中Raymond分级Ⅰ级8例,Ⅱ级3例。另2例患者仅复查磁共振血管成像,未见动脉瘤复发。结论初步观察发现,采用支架"摆尾"技术辅助弹簧圈栓塞伴有fPCA的PCoA宽颈动脉瘤的手术并发症较少,且可有效栓塞动脉瘤。Objective To preliminarily observe the safety and effectiveness of the swinging-tail technique in assisting coil embolization of wide-neck aneurysms of the posterior communicating artery(PCoA)with fetal-type posterior cerebral artery(fPCA).Methods The clinical data of 14 patients with wide-neck aneurysms of the PCoA with fPCA who were treated with the swinging-tail technique to assist coil embolization in the Department of Neurointerventional Radiology,the First Affiliated Hospital of Zhengzhou University from August 2018 to August 2023 were retrospectively analyzed.Technical and operation-related complications were observed.At 6 months post operation,telephone or outpatient follow-up was conducted and patients were reminded to undergo the scheduled whole-brain digital subtraction angiography(DSA).The neurological function status was evaluated by the modified Rankin Scale(mRS),and the embolization effect of the aneurysm was evaluated by Raymond classification.Results All 14 patients achieved technical success,and no operation-related complications occurred.One patient died due to respiratory failure 16 days after the operation.At discharge,there were 11 cases with mRS 0 point,1 case with mRS 1 point,and 1 case with mRS 2 points.At the 6-month follow-up after the operation,the mRS scores of 13 patients were all 0 point.Eleven patients completed DSA follow-up,and the follow-up time[M(Q_(1),Q_(3))]was 7(5,10)months;the results showed that the PCoA was all well opened,and there was no in-stent stenosis,among which there were 8 cases of Raymond gradeⅠand 3 cases of gradeⅡ.Only two patients underwent the examination of magnetic resonance angiography,and no aneurysm recurrence was seen.Conclusion Preliminary observation has demonstrated that the use of the swinging-tail technique to assist coil embolization of wide-neck aneurysms of the PCoA with fPCA has fewer surgical complications and can effectively embolize the aneurysm.

关 键 词：颅内动脉瘤 血管内操作 栓塞 治疗性 后交通动脉 胚胎型大脑后动脉 支架"摆尾"技术 

分 类 号：R743[医药卫生—神经病学与精神病学]