LVIS支架辅助栓塞颅内微小动脉瘤的安全性及疗效分析  

Analysis of Safety and Efficacy of LVIS Stent Assisted Embolization for Intracranial Microaneurysm

作　　者：钱晓敏 苏平[1] 刘博虎 王京 高鸿[1] 刘俊[1] 岑键昌[1] 

机构地区：[1]昆明市第一人民医院神经外科,云南 昆明

出　　处：《医学诊断》2020年第3期137-145,共9页Medical Diagnosis

摘　　要：目的:分析使用LVIS支架辅助栓塞颅内微小动脉瘤的安全性和疗效。方法:回顾性分析了2017年1月至2019年12月使用LVIS支架辅助治疗的23例颅内微小动脉瘤患者临床及随访资料,分析术中并发症、手术效果及预后随访情况。结果:23例颅内微小动脉瘤患者均使用LVIS支架辅助弹簧圈栓塞。23例患者共使用LVIS支架25枚,1例患者置入了双支架,1例患者为2枚颅内微小动脉瘤,置入了两枚支架,支架释放成功率达100%。术中动脉瘤破裂出血1例(4.3%),1例患者出现支架内血栓形成(4.3%)。术后即刻造影,Raymond I级栓塞16枚(66.7%),Raymond II级栓塞6枚(25%),Raymond III级栓塞2枚(8.3%),围手术期未再发生脑出血及脑梗死情况;随访3月至1年,所有患者均复查造影,Raymond I级栓塞22枚(91.7%),Raymond II级栓塞2枚(8.3%),所有LVIS支架均展开良好,无支架移位、分支血管闭塞及血管狭窄情况。随访期间患者mRS评分0分21例,mRS评分2分1例,mRS评分3分1例,预后良好率达到96% (mRS评分0~2分)。结论:LVIS支架辅助栓塞颅内微小动脉瘤是安全有效的方法,能提高动脉瘤治愈率,近期治疗效果良好,但要求术者需具备良好的支架应用技巧,远期疗效仍需多中心、大样本及长时间的随访观察。Objective: To analyze the safety and efficacy of LVIS stent assisted embolization for intracranial microaneurysm. Method: Retrospective analysis was performed on the clinical and follow-up data of 23 patients with intracranial microaneurysms who underwent LVIS stent assisted embolization from January 2017 to December 2019, and the intraoperative complications, surgical effect and prognosis were analyzed. Result: All the 23 patients with intracranial microaneurysm underwent LVIS assisted coil embolization. Twenty five LVIS stents were used in 23 patients;1 patient received dual LVIS stent;two stents were implanted in one patient with 2 intracranial microaneurysms. The success rate of stent release was 100%. There was one case of intraoperative aneurysm rupture and hemorrhage (4.3%). One case developed stent thrombosis (4.3%). Immediate postoperative angiography showed that 16 (66.7%) microaneurysms achieved Raymond grade I embolization;6 (25%) microaneurysms achieved Raymond grade II embolization;2 (8.3%) microaneurysms achieved Raymond grade III embolization. There was no cerebral hemorrhage and cerebral infarction in perioperative period. The follow-up time was 3 months to 1 year. All patients were reexamined angiography during follow-up. 22 (91.7%) microaneurysms achieved Raymond grade I embolization. 2 (8.3%) microaneurysms achieved Raymond grade II embolization. All LVIS stents were well deployed without stent displacement, branch vessel occlusion and vascular stenosis. During the follow-up period, the mRS score was 0 in 21 cases;the mRS score was 2 in 1 cases;the mRS score was 3 in 1 cases;the favorable prognosis (with the mRS score at 0 - 2) rate reached 96%. Conclusion: LVIS stent assisted embolization for intracranial microaneurysms is a safe and effective method. It can improve the cure rate of aneurysm, and the short-term treatment effect is good, but it is required that the operator should have good stent application skills, and the long-term efficacy still needs multi center, large sample and long ter

关 键 词：颅内微小动脉瘤 LVIS支架 预后 安全性 疗效分析 

分 类 号：R74[医药卫生—神经病学与精神病学]