支架后释放技术在颅内宽颈动脉瘤栓塞治疗中的应用

目的探讨支架后释放技术在颅内宽颈动脉瘤栓塞治疗中的安全性、疗效及技术优势。方法回顾分析2007年1月至2009年5月间支架后释放技术（支架输送至载瘤动脉动脉瘤段，先填塞部分弹簧圈后再释放支架）治疗的153例178＂个动脉瘤患者的动脉瘤及载瘤动脉解剖形态，支架植入技术操作程序，临床和造影结果。结果所有动脉瘤均成功植入支架，其中Neuroform支架76枚、Enterprise支架72枚、LEO支架33枚。术后即刻完全栓塞136个动脉瘤（76．4％），瘤颈残留29个（16．3％），部分栓塞13个（7．3％）。术中弹簧圈拉丝1例，血栓栓塞并发症1例。平均术后9．3个月后DSA随访74例，MRA随访44例，显示3例动脉瘤再通。结论支架后释放技术是颅内动脉瘤栓塞治疗中的一种重要手段，能显著提高动脉瘤颈覆盖率而达到血管重建目的，使支架治疗技术成功率、安全性和疗效进一步提高。

Endovascular treatment of intracranial aneurysm using stenting after coiling technique

Objective To evaluate the safety and efficacy, advantages of stenting after coiling technique for wide-necked intracranial aneurysms. Methods A retrospective review of 153 patients with 178 wide-necked intracranial aneurysms treated with stenting after coiling technique from January 2007 to May 2009 was conducted, including aneurysm morphology, procedures, angiographic results and clinical outcomes. Results Stent placement succeeded technically in all of the aneurysms, including 76 Neuro- form stents, 72 Enterprise stents and 33 Leo stents. Total occlusion was achieved immediately in 136 aneurysms （76.4%）, residual neck in 29 （ 16. 3% ） and residual aneurysm in 13 （7.3%）. Procedure related complication occurred in 2 patient （coil strech and thrombosis）. Angiographic follow-up in 118 cases for 9. 3 months showed 3 recanalization （2. 5% ）. Conclusions Our preliminary results suggested that stenting after coiling technique is one important modality for endovascular treatment for wide-necked intracranial aneurysms, facilitating the improvement of neck cover for vascular reconstruction, and technical successful rate, safety and efficacy.