Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤

目的 探讨 Neuroform支架辅助弹簧圈填塞治疗颅内宽颈动脉瘤的技术,并评价临床疗效和并发症.方法 采用Neuroform支架辅助技术对31例颅内宽颈动脉瘤进行了弹簧圈填塞治疗.31例患者共有颅内动脉瘤43枚,均为破裂动脉瘤,其中39枚为宽颈动脉瘤,21枚颈:体≥1,18枚颈:体<1;4枚为宽颈动脉瘤患者合并的非宽颈动脉瘤.结果 31例患者共置入支架35枚,其中3例患者两侧颈内动脉各置入1枚支架,1例两侧大脑中动脉各置入1枚.43枚动脉瘤中41枚进行了不同程度的填塞,2枚末行填塞.2例宽颈动脉瘤患者置入支架后出现非动脉瘤破裂性出血,均可能由于输送导丝损伤大脑中动脉分支引起;1例后交通动脉瘤患者,弹簧圈飘至大脑中动脉M2段,引起相应脑缺血症状.获随访的29例中无死亡病例和再次出血病例,28例生存良好,1例留有明显神经功能障碍.结论 支架辅助技术进行弹簧圈填塞治疗颅内宽颈动脉瘤是安全、有效的临床技术,可以拓宽颅内动脉瘤治疗的适应证.

Neuroform stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms

Objective To discuss the technique of Neuroform stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms and to evaluate its clinical efficacy and complications.Methods Neuroform stent-assisted technique was used for coil embolization treatment in 31 patients with intracranial wide-necked aneurysms, all aneurysms were ruptured and the patients suffered from subarachnoid hemorrhage (SAH). Of the total 43 aneurysms, 39 were wide-necked and 4 were narrow-necked. Results Thirty-five stents were inserted in 31 patients. The stents were implanted in both internal carotid arteries in 3 patients and in both middle cerebral arteries in one patient, Intra-arterial embolization with coils was successfully performed in 41 of 43 aneurysms. Intraoperative hemorrhage occurred in 2 patients, which probably resulted from the rupture of middle cerebral artery branch due to microwire damage. The cerebral isehemic symptom happened in 1 patient with posterior communicating artery aneurysm due to the shifting of the coil from the original site to M2 segment of middle cerebral artery. During a follow-up period of 24.7 months in average, neither death nor recurrent hemorrhage occurred in 29 cases. Twenty-eight patients were in good living condition and the remaining one patient showed obvious disturbance of neural function.Conclusion For the treatment of intracranial wide-necked aneurysms, intra-arterial coil embolization with Neuroform stent-assisted technique is a safe and effective clinical therapy. It can effectively broaden the extent of indications in treating intracranial aneurysms by using interventional technique.