支架技术在颅内复杂动脉瘤治疗中的应用

目的探讨支架在颅内复杂动脉瘤中的治疗技术及应用价值。方法回顾性分析应用支架技术辅助栓塞治疗的31例颅内动脉瘤患者（宽颈动脉瘤28例,梭形动脉瘤3例）的临床资料。术中将支架引至动脉瘤处释放支架覆盖动脉瘤颈,并结合弹簧圈栓塞术。结果 31例共置入支架32枚,其中Enterprise支架24枚,LEO支架5枚,Solitaire AB支架3枚。采用单纯支架置入技术2例,此2例微小动脉瘤术后见瘤腔内造影剂滞留。支架结合弹簧圈治疗29例,其中支架先释放技术7例,支架后释放技术22例,支架结合弹簧圈治疗组取得满意疗效。术后即刻栓塞结果按改良的Raymond分级：动脉瘤体完全栓塞20例（Ⅰ级）,瘤颈残留7例（Ⅱ级）,瘤体显影2例（Ⅲ级）。随访1～6个月未发生再出血及缺血并发症。结论支架辅助栓塞技术是治疗颅内动脉瘤安全有效的方法,可提高动脉瘤栓塞的致密程度,采用支架后释放技术使绝大多数颅内复杂动脉瘤的介入治疗成为可能。

Stenting strategies in the treatment of complex intracranial aneurysms

Objective To explore the stenting strategies and its application value for treatment of complex intracranial aneurysms.Methods The clinical data of 31 patients with intracranial aneurysms（28 with wide necked aneurysms,3 with fusiform aneurysms） treated with the stent implantation were retrospectively analysed.The stent was deployed in the parent artery to cover the neck of aneurysms,combined with endovascular coil.Results Thirty-two stents（24 Enterprise,5 LEO and 3 Solitaire AB） were successfully placed in 31 patients.2 cases were only performed stent implantation,leading to delayed contrast filling.29 cases were performed stent-assisted endovascular coils implanation.Among them,7 aneurysms with stenting before coiling and 22 aneurysms with stenting after coiling.The effects were satisfied in the group,i.e.complete obliteration in 20 aneurysms（RaymondⅠ）,residual neck in 7（RaymondⅡ）,residual aneurysm in 2（RaymondⅢ）.Following-up for 1-6 months,no newly-developed bleeding or infarction.Conclusion Stenting-assisted coiling for the treatment of intracranial aneurysms is a safe and efficient technique that could increase density of coil packing.So that the majority of complex intracranial aneurysms can be successfully treated with stenting after coiling.