Y型支架植入技术治疗颅内分叉部宽颈动脉瘤三例并文献复习

目的 探讨Y型支架植入技术治疗颅内分叉部宽颈动脉瘤的可行性.方法 回顾性收集第二军医大学附属长海医院神经外科采用Y型支架植入技术治疗的3例患者共3枚分叉部宽颈动脉瘤的临床资料,应用多个关键词检索Pubmed数据库,总结并分析相关的文献资料.结果 本组病例共应用支架6枚,其中Neuroform支架5枚,Enterprise支架1枚.所有支架均成功释放,动脉瘤致密栓塞2例,瘤颈残留1例.1例患者术后出现短暂性神经功能缺损,未发生与手术相关的永久并发症.经7～21个月的临床随访,3例患者均恢复良好,无临床症状加重,亦未发生再出血.Pubmed数据库检索共得到5篇相关文献,结合本组资料,应用该技术治疗分叉部宽颈动脉瘤患者共21例.技术成功率为95.2%(20/21),报道即刻栓塞结果的18枚动脉瘤中16枚(88.9%)达到致密栓塞或瘤颈残留;发生与技术相关的暂时性并发症5例(23.8%),未发生任何技术相关的永久性并发症.结论 Y型支架植入技术辅助栓塞颅内分叉部宽颈动脉瘤初步可行,其安全性及有效性有待于对大宗病例进行总结和分析后作进一步评价.

Y-configuration stent placement in treatment of wide-necked intracranial bifurcation aneurysms: a report of 3 cases and review of literature

Objective To evaluate the feasibility of using Y-configuration stent placement for the treatment of wide-necked intracranial bifurcation aneurysms. Methods The clinical data of 3 patients with 3 wide-necked intracranial bifurcation aneurysms, who were treated with Y-configuration stenting technique, were retrospectively analyzed. We also performed literature retrieval using multiple key words in Pubmed and summarized, analyzed the retrieved data. Results In our 3 cases, a total of 6 stents (5 Neuroform stents and 1 Enterprise stent) were successfully implanted; complete occlusion was achieved in 2 cases and residual neck in 1. One patient had temporary neurological deficit after operation, which was resolved by conservative treatment, with no procedure-related permanent complications. Follow-up (7-21 months) demonstrated that the 3 patients recovered well, with no symptom deterioration or re-bleeding. Five related articles were finally obtained by Pubmed retrieval; together with our 3 cases, totally 21 wide-necked bifurcation aneurysms were treated by the same technique, with a successful rate of 95.2% (20/21). Sixteen of their 18 aneurysms (88.9%) were obliterated completely or with a residual neck. There were 5 procedure-related temporary complications (23.8%), leading to no mortality or morbidity. Conclusion Y-configuration stenting technique is technically feasible for treatment of wide-necked intracranial bifurcation aneurysms. Further studies with more cases are needed to evaluate its safety and long-term efficacy.