双微导管技术栓塞复杂颅内动脉瘤

研究背景尽管球囊或支架辅助栓塞技术已在临床广泛应用,但是对于结构复杂的颅内动脉瘤如相对宽颈的微小动脉瘤或宽颈分叶状、有重要分支血管自瘤颈部或体部发出的动脉瘤,微弹簧圈栓塞治疗仍是一种挑战。本研究旨在评价双微导管技术栓塞结构复杂颅内动脉瘤的可行性和临床疗效。方法与结果 33例复杂颅内动脉瘤位于前交通动脉(7例)、后交通动脉(14例)、眼动脉段(3例)、脉络膜前动脉(3例)、小脑后下动脉起始部(3例)、大脑中动脉分叉部(2例)和基底动脉顶端(1例)。动脉瘤颈宽/体宽平均为0.80±0.21(0.53～1.33)、体宽/高度为1.12±0.37(0.55～2.12)和高度/颈宽为1.26±0.41(0.65～2.96);瘤颈直径≥4mm者7例、颈宽≥高度者9例、颈宽≥体宽者8例;微小动脉瘤(最大径≤3mm)9例,有重要分支血管自瘤颈发出者13例。均采用双微导管技术施行微弹簧圈栓塞治疗,并且获得成功,其中动脉瘤致密填塞19例、瘤颈残留14例,术后脑血管造影检查12例弹簧圈襻突出于瘤颈之外,但均不影响血流。出院时改良Rankin量表评分2分者3例、0～1分者30例;仅1例患者术后1年行脑血管造影检查显示瘤颈微弹簧圈少许压缩,且动脉瘤瘤颈呈"狗耳朵"样再通显影。结论双微导管技术栓塞颅内复杂动脉瘤可行、安全、有效。

Double microcatheter technique for coiling intracranial aneurysms with unfavorable configurations

Background Although stent-assisted technique has been widely used clinically, it is still hard to perform coiling treatment for complicated intracranial aneurysms, including relatively wide- necked tiny aneurysms and lobulated wide-necked aneurysms with important branch vessels arising from the neck. This study aims to investigate the feasibility and clinical results of endovaseular treatment for intraeranial aneurysms with unfavorable configurations by using double mierocatheter technique. Methods Thirty-three cases with complicated aneurysms were treated by using double microeatheter technique from April 2008 to November 2012. The locations of these aneurysms were anterior communicating artery （7 cases）, posterior communicating artery （14 cases）, ophthalmic artery （3 cases）, anterior choroidal artery （3 cases）, origin of posterior inferior eerebellar artery （3 cases）, bifurcation of middle cerebral artery （2 cases） and top of basilar artery （1 case）. The mean neck-to-body （width） ratio was 0.80 ＋ 0.21 （0.53-1.33）. The mean body （width）-to-dome （height） ratio was 1.12-± 0.37 （0.55-2.12）. The mean dome （height）-to-neck ratio was 1.26 ± 0.41 （0.65-2.96）. The diameter of neck ≥ 4 mm was seen in 7 aneurysms, neck i〉 height in 9 and neck ≥ width in 8. Besides, there were 9 very small aneurysms （the maximum diameter ≤ 3 mm） and 13 aneurysms with important branch vessels arising from the neck. All of these aneurysms were treated with coiling by using double microcatheter technique. Results All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in 19 aneurysms, and residual filling in 14. There were some small loops protruding from the neck without influencing the blood flow in 12 cases. At discharge, according to modified Rankin Scale （mRS）, 30 patients with 0-1 scores presented excellent clinical outcomes and 3 patients with 2 scores had cognitive dysfunction and moderate disability due to vasospasm. Among the 33 cases, only 1 case receiving follow-up angiography 1 year after operation showed the coils near the neck were slightly compressed andpresented a dog ear like recanalization. Conclusion According to the clinical experience with complicated aneurysms, double microcatheter technique is feasible, safe and effective for coil embolization of aneurysms with unfavorable configurations.