血流导向支架治疗颈内动脉血泡样动脉瘤  

Flow diverter stents for blood blister-like aneurysms of the internal carotid artery

作　　者：樵凡原 王飞[1] 张昌伟[2] QIAO Fanyuan;WANG Fei;ZHANG Changwei(Department of Neurosurgery,Affiliated Jiangjin Hospital of Chongqing University,Chongqing 402260,China)

机构地区：[1]重庆大学附属江津医院神经外科,重庆402260 [2]四川大学华西医院神经外科

出　　处：《介入放射学杂志》2025年第2期134-139,共6页Journal of Interventional Radiology

摘　　要：目的评估使用血流导向支架治疗血泡样动脉瘤(blood blister-like aneurysms,BBA)的安全性及有效性。方法回顾性分析2022年1月至2023年6月四川大学华西医院收治的14例BBA患者的临床及影像学数据,包括基线资料、动脉瘤数据、手术方式、手术相关并发症以及随访结果。结果14例患者中,有5例使用Pipeline血液导向装置(Pipeline embolization device,PED)辅助弹簧圈栓塞,有3例单纯使用PED,有5例使用Tubridge密网支架(TB)辅助弹簧圈栓塞,有1例单纯使用TB。4例单纯使用血流导向支架的患者术后即刻造影时见动脉瘤内造影剂滞留,余均未见动脉瘤显影。1例使用TB辅助弹簧圈栓塞的患者术后并发迟发性大面积脑梗死导致死亡。1例单纯使用PED的患者出现右侧肢体偏瘫,随访时改良Rankin(mRS)评分为2分;余12例患者在出院时及随访时mRS评分均为0分。13例患者随访时造影见动脉瘤完全闭塞。结论血流导向支架辅助弹簧圈栓塞或单纯使用血流导向支架治疗BBA安全有效,但围术期有潜在动脉瘤再出血和脑梗死风险。Objective To evaluate the safety and efficacy of flow diverter stent(FDS)implantation in treating blood blister-like aneurysms(BBA).Methods The clinical data and imaging findings(including baseline data,aneurysm data,surgical pattern,surgery-related complications and follow-up results)of 14 patients with BBA,who were admitted to West China hospital of Sichuan University from January 2022 to June 2023,were retrospectively analyzed.Results Of the 14 patients with BBA,pipeline embolization device-assisted(PED-assisted)coil embolization was performed in 5,only PED in 3,Tubridge close-mesh stent(TB)-assisted coil embolization in 5,only TB in one.In the 4 patients receiving only FDS,the immediate postoperative angiography showed that retention of contrast agent was seen in the aneurysm,and no aneurysm visualization was seen in the remaining patients.One patient,who received TB-assisted coil embolization,developed postoperative delayed massive cerebral infarction and died.One patient,who received only PED,developed right limb hemiplegia with an mRS score of 2 points at follow-up visit.In the remaining 12 patients,the mRS score was 0 point at the time of discharge as well as at the time of follow-up visit.In 13 patients,follow-up angiography demonstrated that the aneurysm was completely occluded.Conclusion For the treatment of BBA,FDS-assisted coil embolization or single FDS is clinically safe and effective,although there is potential risk of perioperative aneurysm rebleeding and cerebral infarction.

关 键 词：血泡样动脉瘤 血流导向支架 颈内动脉 弹簧圈栓塞 血管内治疗 

分 类 号：R743.35[医药卫生—神经病学与精神病学]