支架结合弹簧圈栓塞颅内复杂动脉瘤

目的探讨和总结支架结合弹簧圈血管内治疗颅内宽颈、梭形等复杂动脉瘤的技术及疗效。方法回顾性分析颅内支架结合可脱弹簧圈治疗41例44个颅内宽颈、梭形动脉瘤的临床资料。结果支架结合弹簧圈完成栓塞40个动脉瘤(其中1例采用"Y"型双支架),动脉瘤100%栓塞23个,95%栓塞11个,90%栓塞5个,80%栓塞1个;4个微小动脉瘤单纯植入支架未填塞瘤体。死亡2例,1例死于血小板功能障碍所致脑干出血,1例单纯放置支架术后13d死于再次蛛网膜下腔出血。32例随访3～18个月无再出血及脑梗死,7例失访;24例26个动脉瘤术后3～18个月接受血管造影,与栓塞后即刻血管造影相比,影像学无变化者14个,7个瘤颈残留者已不显影,1个100%栓塞者瘤颈少许显影,1个90%栓塞者瘤颈显影稍有增大;3个单纯放置支架未填塞动脉瘤腔的动脉瘤中2个不显影,1个体积有所缩小。结论支架结合弹簧圈栓塞颅内复杂动脉瘤有较好的疗效,但应警惕抗血小板药物所致的风险,特别对于未能有效填塞瘤腔的动脉瘤。

Endovascular embolization of complex intracranial aneurysms by stents combined with detachable coils

Objective To explore the technique of endovascular treatment of complex intracranial aneurysms with the stents combined with detachable coils and its curative effects on them.Methods The clinical data of 41 patients with 44 wide-necked or fusiform intracranial aneurysms which were endovascularly embolized by the stents combined with detachable coils were analyzed retrospectively.Results Of 44 aneurysms,40 were successfully embolized by the stents combined with coils and 4 which were microaneurysms were treated only by the stents.Of 40 aneurysms embolized by the stents combined with coils,23 were completely occluded,11 occluded by 95%,5 occluded by 90%,and 1 occluded by 80%.Two patients died respectively from brain stem hemorrhage due to thrombasthenia and from the rerupture and rebleeding of the aneurysms treated only by the stent 13 days after the treatment.There were not rebleeding and cerebral infarction in 32 patients followed up from 3 to 18 months.The cerebral angiography 3～18 months after the treatment in 24 patients with 26 aneurysms showed that imaging was similar to that immediately after the treatment in 14 aneurysms,the residual aneurysmal necks disappeared in 7 and increased in 2 occluded respectively by 100% and 90%,2 aneurysms treated only by stents disappeared because of the thrombosis in the aneurismal cavities and the volume of 1 aneurysm treated only by the stent decreased.Conclusions The curative effects of endovascular embolization by stents combined with detachable coils on the complex intracranial aneurysms are good.Anti-platelet drug-induced risks should be paid attention to in the patients with aneurysms,especially not effectively embolized aneurysms.