新型可伸缩的自膨式支架在颅内宽颈动脉瘤血管内治疗的应用

目的 了解和总结新型可伸缩的自膨式支架(LEO)在辅助栓塞治疗颅内宽颈动脉瘤的性能和初步应用体会.方法 应用LEO支架辅助微弹簧圈治疗颅内宽颈动脉瘤10例(其中1例患者4个动脉瘤,1个用LEO,2个用其他支架,1个未处理).LEO支架6例采用半释放技术,即先释放一半支架,再填微弹簧圈,待弹簧圈栓塞完全,将支架完全释放;2例采用先填微弹簧圈,待弹簧圈栓塞完全,再在动脉瘤开口覆盖LEO支架;2例先释放LEO支架,微导管穿过支架网眼,再填塞微弹簧圈,将动脉瘤栓塞.在释放支架过程中,支架可自如进出其外套管(VASCO+),使之安放在动脉瘤口外最佳位置.结果 9例应用LEO辅助的动脉瘤都被完全栓塞,1例部分栓塞.但1例蛛网膜下腔出血24h病人,急诊栓塞后,支架内出现血栓并发症,经溶栓将支架内栓塞溶开;2例在支架输送过程中,支架在体外脱落,在体外徒手安装成功.结论 新型可伸缩的自膨式支架可自如安放在宽颈动脉瘤开口的最佳位置,由于其在微管内走行,输送方便,为颅内宽颈动脉瘤的血管内治疗提供了有利武器.

Preliminary experience on new retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms

Objective To evaluate the preliminary experience on new retractable self-expandable stent(LEO)for endovascular treatment of wide-necked intracranial aneurysms and its nature.Method 10 wide-necked intracranial aneurysms were embolized with LEO stent in combination with detachable coils.Six cases were treated by staged release of the LEO stent.Stent delivery cross the aneurismal neck after endovascular coiling of aneurysms was performed in 2 cases.In another two cases,aneurysms were coiled endovascularly after LEO stent release.The delivery system iS advanced inside the Vasco microcatheter.We could pull the catheter and the stent back until the distal end of the stent was precisely positioned.Results Nine aneurysms were all embolized completely with stent-coil technique.and 1 case was partially embolized.There was a thromboembolic event related to the deployment of the Leo stent in one patient with acute subarachnoid hemorrhage,which was cured without complications.The stent could be resheathed and repositioned if needed.Conclusions The Leo stent can be deployed accurately within the cerebral vasculature.It is a feasible,secure,and effective system on treating wide-necked intracranial aneurysms and in combination with coiling embolization offers a promising therapeutic alternative in the treatment of widenecked aneurysms.