Enterprise支架在颅内动脉瘤治疗中的应用

目的评价Enterprise支架在颅内动脉瘤治疗中的应用价值及安全性。方法 2008年12月～2011年3月应用Enterprise支架(美国Codman公司)治疗颅内动脉瘤21例,其中宽颈动脉瘤19例,梭形动脉瘤2例。在微导丝引导下,将支架输送导管送至动脉瘤颈以远,通过输送导管将支架引至动脉瘤处释放支架覆盖动脉瘤颈,行弹簧圈栓塞术。结果采用单纯支架置入技术2例,支架先释放技术5例,支架后释放技术14例。21例22枚支架置入顺利,全部成功释放,位置良好。术后即刻血管造影显示动脉瘤致密性栓塞13例,大部栓塞6例,单纯支架置入的2例微小动脉瘤见瘤腔内造影剂滞留。除1例驼背病人术后1周并发肺部感染死亡外,余20例随访1～6个月无临床症状加重,未发生脑再出血或新发梗死;11例术后6～12个月行DSA,2例动脉瘤瘤颈有残留,未见支架移位和支架内狭窄。结论 Enterprise支架操作简便,易通过血管弯曲处并准确释放,为颅内动脉瘤提供了较为安全有效的治疗方法。

Enterprise Stent Implantation for Intracranial Aneurysm

Objective To assess the feasibility and safety of Enterprise stent in the treatment of intracranial aneurysm.Methods Since December 2008 to March 2011,we used Enterprise sent(Codman,US) to treat intracranial aneurysm in 21 cases,including 19 cases of wide-neck aneurysm and 2 cases of fusiform aneurysm.With the guidance by a microcatheter,we placed a stent at the distal side of the aneurysm,and then deployed the stent through the microcatheter in the parent artery over the neck of the aneurysm;after that coiling of aneurysms was performed to achieve adequate occlusion. Results In two of the cases,simple stenting was carried out,in 5 patients,the stenting was performed before coiling,and in the other 14,stenting was made after coiling.The procedure was completed successfully in 21 of the 22 cases,with all stents delivered successfully and deployed accurately in the desired location.Immediate postprocedural angiography demonstrated total occlusion in 13 patients,partial occlusion in 6 patients,and delayed contrast-medium filling in 2 patients who had micro aneurysm and recieved stenting alone.In the 21 patients,one patient,who had hunchback,died of pulmonary infection at 1 week postprocedurally;the other 20 patients were followed up for 1-6 months,during which no signs of aggravation,newly-developed bleeding or infarction;11 of the patients received DSA at 6-12 months after operation,which showed residual neck of the aneurysm,no in-stent stenosis or stent migration was observed. Conclusion The Enterprise stent implantation is a simple,safe and effective method in the treatment of intracranial aneurysms.