支架治疗介入栓塞术后复发颅内动脉瘤的回顾性研究

目的 评价支架治疗介入栓塞后复发颅内动脉瘤的可行性、安全性和有效性。
方法 回顾性分析第二军医大学附属长海医院神经外科2006年6月～2013年3月应用支架治疗的介入栓塞术后复发颅内动脉瘤病例，共83例患者、83枚复发动脉瘤。对患者的临床、影像学资料、治疗方案、治疗结果、并发症及预后等进行分析。
结果 所有83例患者共应用93枚支架，支架植入顺利，技术成功率100%。动脉瘤即刻治疗结果，33例单纯支架植入术的病例中，18例（54.5%）术后即刻动脉瘤内造影剂滞留，15例（45.5%）单纯支架植入术后即刻数字减影血管造影（digital substraction angiography，DSA）同术前相比无明显改变。支架结合弹簧圈治疗的50例患者中，按Raymond分级，Ⅰ级11例（22.0%），Ⅱ级21例（42.0%），Ⅲ级18例（36.0%），载瘤动脉均保持通畅。共发生与支架植入术相关并发症2例（2.4%），均为脑血管痉挛，给予动脉灌注罂粟碱后好转，出院时无神经功能损害。出院时改良Rankin量表（modified Rankin Scale，mRS）评分：0～2分82例（98.8%），3分1例（1.2%）。影像学随访50例（60.2%）患者，随访时间2～52个月，中位随访时间11个月。单纯支架植入随访20例结果显示：致密栓塞14例（70.0%），动脉瘤内进一步血栓形成3例（15.0%），动脉瘤稳定3例（15.0%）。支架辅助弹簧圈栓塞30例随访结果为：致密栓塞20例（66.7%），进一步血栓形成3例（10.0%），稳定3例（10.0%），小复发2例（6.7%），大复发1例（3.3%），再次破裂出血1例（3.3%）。所有患者均获临床随访，随访时间2～82个月，中位随访时间30个月，除发生再出血的患者接受再次治疗并痊愈外，均无新发神经功能缺损。
结论 颅内支架治疗颅内复发动脉瘤技术上可行，安全性高，结果满意，但长期疗效仍有待进一步随访。

Use of Stents in Repeat Endovascular Treatment of Post-embolization Recurrent Intracranial Aneurysms

Objective To evaluate the feasibility, effectiveness, and safety of recurrent aneurysm treatment with stent.Methods A retrospective review was conducted for 83 patients with recurrent intracranial aneurysms who underwent endovascular treatment with stent in Department of Neurosurgery, Changhai Hospital, between June 2006 and March 2013.Results For these 83 patients with recurrent aneurysms, 93 stents were deployed successfully, and 10 patients received dual stent placement. Among them, 33 patients were treated with stent placement alone and 50 patients received stent-assisted coil embolization. In the patients treated with stent placement alone, residual iflling of contrast medium in the aneurysms was seen in 18 patients （54.5%） immediately after the stent placement. However, no obvious difference was seen in 15 patients （45.5%）. Of the 50 aneurysms treated with stent-assisted embolization, complete occlusion was achieved in 11 aneurysms （22.0%）;residual neck remained in 21 aneurysms （42.0%）, and residual aneurysm was present in 18 aneurysms （36.0%）. Procedure-related complication occurred in 2 patients. They both suffered vasospasm and was discharged with no deifcit. The modiifed Rankin Scale （mRS） score at discharge was 0-2 in 82 patients （98.8%） and 3 in one patient （1.2%）. Follow-up angiographies were available in 50 （60.2%） patients （ranging 2-52 months, median 11 months）. The results of 20 patients treated by stent placement alone showed complete occlusion in 14 （70.0%）, progressive occlusion in 3 （15.0%） and stable in 3 （15.0%）. Follow-up of 30 patients treated by stent assisted coil embolization showed complete occlusion in 20 （66.7%）, progressive occlusion in 3 （10.0%）, stable in 3 （10.0%）, minor recanalization in 2 （6.7%）, major recanalization in 1 （3.3%） and rerupture in 1 （3.3%）. The clinical follow-up （ranging 2-82 months, median 30 months） demonstrated no neurologic deterioration except the one suffering SAH, who received endovascular treatment again without neurologic deifcit.
Conclusion The treatment of recurrent intracranial aneurysms with stents can be successfully achieved with satisfactory midterm results.