编织铆定技术在颅内破裂不规则宽颈动脉瘤栓塞中的应用

目的 探讨编织铆定技术辅助栓塞治疗颅内破裂不规则宽颈动脉瘤的效果。方法 回顾性分析2016年1月至2019年6月应用编织铆定技术辅助栓塞治疗的36例颅内破裂不规则宽颈动脉瘤的临床资料。结果 36例动脉瘤均成功栓塞，其中26例单纯通过编织铆定技术栓塞，没使用支架、球囊辅助技术，无弹簧圈脱出，编织铆定技术成功率为72.22%；10例（27.78%）经过反复调整，仍然有弹簧圈突入载瘤动脉，给予补救性支架辅助栓塞。术后即刻造影显示动脉瘤完全栓塞29例（90.36%），次全栓塞7例（9.64%）。无术中出血事件，无栓塞事件。36例术后6个月CTA或DSA随访，采用编织铆定技术栓塞26例中，2例瘤颈处部分复发，再次补充栓塞；而使用补救性支架辅助栓塞的10例无复发。结论 对于颅内破裂不规则宽颈动脉瘤，急性期不适合使用支架辅助栓塞时，只要选择好适应证、掌握好技术要点，单根微导管编织铆定技术虽然不能栓塞所有的宽颈不规则动脉瘤，而且有一定的复发率，但能够明显降低急性期支架的使用率，对一些病人达到很好的治疗效果。

Clinical efficacy of endovascular treatment for ruptured irregular wide-necked intracranial aneurysms using knitting-riveting embolization technique

Objective To investigate the clinical efficacy of endovascular embolization using knitting-riveting embolization (KRE) technique for the patients with ruptured irregular wide-necked intracranial aneurysm (RIW-ICA). Methods The clinical data of 36 patients with RIW-ICA who received endovascular treatment using KRE technique from January 2016 to June 2019 were analyzed retrospectively. Results Successful embolization was performed on these 36 patients, of whom 26 patients were embolized only using KRE technique without stent- and balloon-assisted techniques and the successful use rate of KRE technique was 72.22%. The other 10 patients (27.78%) received a salvage stent-assisted embolization because the coils protruded into the parent arteries after repeated adjustment of the micro catheters. Immediate postoperative angiography showed that complete embolization was achieved in 29 patients (90.36%) and subtotal embolization in 7 (9.64%). There were no intraoperative bleeding events and no embolic events. The follow up by CTA or DSA 6 months after operation showed that partial recurrence at the aneurysm neck occurred in 2 patients of 26 patients who were embolized using KRE technique, and there was no recurrence in 10 patients receiving the salvage stent-assisted embolization. Conclusions For patients with RIE-ICA, when stent-assisted embolization is not suitable in the acute stage, the KRE technique using a single microcatheter can achieve a good outcome and reduce the use of stents under the premise of grasping the surgical indications and mastering the technical points.