LVIS支架治疗大脑中动脉分叉部未破裂动脉瘤的临床效果分析

目的 评价LVIS(low profile visualized intraluminal support)支架治疗大脑中动脉(MCA)分叉部未破裂动脉瘤的安全性和有效性.方法 回顾性连续纳入2014年10月至2018年12月海军军医大学第一附属医院神经外科收治的所有LVIS支架治疗的MCA分叉部未破裂动脉瘤患者58例(58个MCA分叉部未破裂动脉瘤).收集患者的一般资料以及临床资料,一般资料包括年龄、性别和血管危险因素等;临床资料包括动脉瘤的基本特征(动脉瘤最大径、瘤颈大小、远近端载瘤动脉直径)、治疗结果、随访资料等.根据Raymond分级评价术后即刻栓塞程度,影像学随访采用DSA和(或)MR血管成像(MRA),临床预后采用门诊和(或)电话随访.术后6个月行DSA随访,此后间隔1~2年行MRA及临床随访.与术后即刻栓塞结果对比,影像学随访治愈为动脉瘤不显影,改善为显影较前减少,稳定为显影同前,复发为显影较前增多.采用改良Rankin量表(mRS)评分评估临床预后,预后良好为mRS评分≤2分,预后不良为mRS评分3~5分,死亡为mRS评分6分.结果 58例患者均成功实施LVIS支架辅助栓塞治疗,术后即刻造影显示,动脉瘤Raymond分级Ⅰ级26例(44.8%),Ⅱ级11例(19.0%),Ⅲ级21例(36.2%).围手术期并发症发生率为3.4%(2/58),包括1例操作相关出血并发症和1例血栓栓塞并发症.48例患者接受DSA随访[5~49个月,中位随访时间8.0(6.0,12.0)个月],其中37个(77.1%)动脉瘤治愈,3个(6.2%)改善,6个(12.5%)稳定,2个(4.2%)复发;1例发生支架内狭窄,2例分别为被LVIS支架覆盖的分支血管发生狭窄和闭塞,均无症状.58例患者完成了临床随访[5~49个月,中位时间9.0(6.0,15.8)个月],未发生出血及缺血事件.结论 LVIS支架可尝试用于MCA分叉部未破裂动脉瘤,但其对分支血管的影响还需要进一步研究.

Clinical efficacy of endovascular treatment with the low profile visualized intraluminal support stent for unruptured aneurysm of middle cerebral artery bifurcation

Objective To evaluate the safety and efficacy of endovascular treatment with low profile visualized intraluminal support(LVIS)stent for unruptured aneurysms of middle cerebral artery(MCA)bifurcation.Methods The study retrospectively reviewed continuous patients with unruptured aneurysms of MCA bifurcation treated with LVIS device in our institution from October 2014 to December 2018.Fiftyeight patients with 58 unruptured aneurysms of MCA bifurcation were identified.The data of patients were collected such as baseline characteristic,imaging,outcomes and followup.Results A total of 58 patients were successfully treated with stentassisted embolization.Immediate postoperative angiograms showed there were the levelⅠof Raymond in 26 aneurysms(44.8%),levelⅡin 11 aneurysms(19.0%),and levelⅢin 21 aneurysms(36.2%).There were 2 patients(3.4%)with Perioperative complications,including one procedurerelated hemorrhagic event and one thromboembolic event.The followup angiogram was available in 48 aneurysms,which revealed that 37(77.1%)aneurysms were occluded,3(6.2%)were improved,6(12.5%)were stable,and 2(4.2%)were recurrent.During the followup,1 patient was found with instent stenosis,and 2 patients presented branch vessel covered by LVIS stent causing stenosis and occlusion.All these 3 patients were asymptomatic.There was no hemorrhagic,and thromboembolic event during clinical followup.Conclusions The endovascular treatment for unruptured aneurysms of MCA bifurcation with LVIS stent is safe and effective,but the effect on branch vessel needs to be further studied.