Wallstent支架重叠植入治疗颈内动脉颅外段大型或巨大型动脉瘤的临床研究  

Clinical study of overlapping Wallstent stent implantation in large or giant extracranial internal carotid artery aneurysms

作　　者：田奇 史帅龙 龙树海 马骥[1] 王晔[1] 李晓[1] 苗仁英 宋燕[2] 李腾飞[1] Tian Qi;Shi Shuailong;Long Shuhai;Ma Ji;Wang Ye;Li Xiao;Miao Renying;Song Yan;Li Tengfei(Department of Interventional Radiology(Institute of Interventional Therapy of Zhengzhou University),First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Vascular Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州大学介入治疗研究所,郑州450052 [2]郑州大学第一附属医院血管外科,郑州450052

出　　处：《中华神经医学杂志》2024年第11期1086-1093,共8页Chinese Journal of Neuromedicine

基　　金：河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029);河南省高等学校重点科研项目(24A320038);河南省科技攻关项目(242102310109)。

摘　　要：目的探讨Wallstent支架重叠植入治疗颈内动脉颅外段大型(15 mm≤直径<25 mm)或巨大型(直径≥25 mm)动脉瘤的疗效和安全性。方法回顾性收集郑州大学第一附属医院放射介入科自2015年8月至2023年6月采用Wallstent支架重叠植入治疗的23例颈内动脉颅外段大型或巨大型动脉瘤患者的临床资料。术后即刻采用DSA评估支架植入后动脉瘤内对比剂滞留情况,采用高分辨率C形臂CT(HR-CBCT)图像评估2枚支架间以及支架与血管内壁的贴壁程度。记录患者围手术期的并发症发生情况;出院后每2个月进行临床随访,末次临床随访时采用改良Rankin量表(mRS)评估患者的预后(mRS评分0~2分定义为预后良好)。术后6个月采用DSA评估动脉瘤闭塞情况。末次影像学随访时采用DSA或CTA评估支架内再狭窄情况。结果22例患者顺利于血管病变处重叠植入2枚Wallstent支架,1例患者在植入支架过程中动脉瘤远心端颈动脉出现血管夹层并造成血流受限,后跨越病变由远及近依次植入1枚Neuroform EZ支架和2枚Wallstent支架后血流恢复通畅,技术总体成功率为95.7%(22/23)。术后即刻DSA显示23例患者动脉瘤内均可见明显对比剂滞留。HR-CBCT显示21例患者2枚Wallstent支架间及支架与血管内壁间贴壁良好,2例患者瘤颈处2枚支架间轻度贴壁不全。23例患者获得临床随访,随访时间(11.5±6.3)个月,末次随访时患者均预后良好。23例患者获得影像学随访,随访时间(10.4±3.4)个月,术后6个月DSA显示19例患者的动脉瘤完全闭塞(OKM分级D级),4例患者的动脉瘤瘤颈处少许对比剂残余(OKM分级C级);末次影像学随访显示2例患者(采用DSA评估)支架内狭窄(狭窄率分别为51%和87%),经给予支架内球囊扩张后狭窄明显改善,余21例患者(采用CTA评估)支架内血流通畅,且动脉瘤未见显影。结论Wallstent支架重叠植入治疗颈内动脉颅外段大型或巨大型动脉瘤疗效较好,安全�ObjectiveTo assess the efficacy and safety of overlapping braided carotid artery stent(Wallstent)implantation in large extracranial internal carotid artery aneurysms(15 mm≤diameter<25 mm)and giant ones(diameter≥25 mm).MethodsA retrospective study was performed;the clinical data of 23 patients with large or giant extracranial internal carotid artery aneurysms accepted overlapping Wallstent stent implantation in Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University from August 2015 to June 2023 were collected.Immediately after implantation,DSA was used to evaluate the retention of contrast agent within the aneurysms and high-resolution C-arm CT(HR-CBCT)was used to detect the apposition between the two stents and between the stents and inner wall of the blood vessel.Perioperative complications were recorded.Clinical follow-up was performed bi-monthly via outpatient visits or telephone,and modified Rankin scale(mRS)was used to assess the prognoses(mRS scores of 0-2 as good prognosis)at the last follow-up;aneurysm occlusion was evaluated in a 6-month follow-up by DSA and in-stent restenosis in a final imaging follow-up by DSA or CTA according to the OKM grading.ResultsTwenty-two patients had successful overlapping implantation of 2 Wallstent stents;blood flow was restricted in one patient due to carotid artery dissection at the distal end of the aneurysm during stent implantation and restored after a Neuroform EZ stent and 2 Wallstent stent implantation from the distal-proximal lesion;technical success rate of 95.7%(22/23)was obtained.DSA immediately after implantation showed obvious contrast medium retention in all aneurysms.HR-CBCT indicated good stent apposition in 21 patients and mild incomplete stent apposition in 2.Clinical follow-up was finished in 23 patients,ranged 6-31 months(mean 11.5±6.3 months);all patients had good prognosis at the last follow-up.Imaging follow-up,including at least once DSA,was conducted for all patients,with intervals ranging from 6 to 15 months(

关 键 词：颈内动脉颅外段动脉瘤 Wallstent支架 高分辨率C形臂CT 支架贴壁不良 

分 类 号：R743[医药卫生—神经病学与精神病学]