覆膜支架血管内治疗颅内动脉瘤:附九例报告

目的探讨覆膜支架治疗颅内动脉瘤的适应证和临床疗效。方法经脑血管造影检查明确诊断的9例颅内动脉瘤患者(4例颈内动脉海绵窦段宽颈动脉瘤未破裂、5例椎动脉颅内段梭形或夹层动脉瘤破裂致蛛网膜下隙出血),动脉瘤直径4～16mm,均接受Jostent覆膜支架治疗。结果共计植入9枚Jostent覆膜支架,均获技术成功,支架顺利到达病变部位且释放后动脉瘤颈即刻覆盖完全,动脉瘤不显影,载瘤动脉血流通畅,达到即刻影像学满意效果。随访9～24个月,5例患者(2例颈内动脉、3例椎动脉)脑血管造影检查颈内动脉支架段血流通畅、无狭窄(2例),椎动脉支架段血管呈无症状性闭塞(2例)或支架内轻度狭窄(1例),动脉瘤均未显影;其余4例未行脑血管造影患者门诊随访。9例患者手术后均恢复正常生活与工作,无一例死亡或永久性病残。结论覆膜支架治疗颈内动脉海绵窦段宽颈大动脉瘤、椎动脉颅内段梭形或夹层动脉瘤疗效较好,值得在有手术适应证的患者中推荐使用。

Endovascular treatment of intracranial aneurysms with covered stents(with report of 9 cases)

Objective To evaluate the effectiveness and indications of endovascular treatment of intracranial aneurysms with covered stents.Methods During the last 5 years,9 patients with intracranial aneurysms were selected and treated by endovascular implantation 9 coronary stent grafts(Jostent GraftMaster).The 9 patients were 28-65 years old(average 46).There were 4 cases with internal carotid cavernous wide neck unruptured aneurysms.Among them 3 patients suffered with diplopia whose aneurysmal diameters were 12-16 mm,and the other one suffered with transient ischemic attack(TIA) whose internal carotid cavernous segment stenosis associated with a wide neck aneurysm(diameter 4 mm). Five cases suffered from intracranial vertebral dissecting or fusiform aneurysms with subarachnoid hemorrhage(SAH).The Hunt-Hess degrees wereⅠ-Ⅱ.The aneurysmal diameters were 4-6 mm.Before operation all patients administrated clopidogrel 75 mg and aspirin 300 mg per day at least for 3 d.All patients were treated with Jostent covered stent.Results The stent placement was successful.All covered stents were successfully deployed in the parent artery across the lesions.All aneurysms were excluded immediately.Five of 9 patients(2 carotid and 3 vertebral) were followed by cerebral angiography for 9-24 months after treatment.At stent placement carotid artery blood flow became fluent and no stenosis was seen in 2 cases,vertebral arteries were asymptomatic occluded in 2 cases,and slightly in-stent stenosis at vertebral artery was seen in one case.No aneurysms recurred.The other 4 cases did not undergo angiography were followed as outpatients.All patients recovered normally.No death or permanant disablement occurred.Conclusion Endovascular covered stent placement is expedient and effective for treatment of internal carotid cavernous large and wide neck aneurysms and intradural vertebral dissecting or fusiform aneurysms.