Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效

目的评价Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效。方法2007年至2011年应用Neuroform3支架辅助弹簧圈栓塞118例脑动脉瘤,其中86例为破裂出血性动脉瘤,32例为未破裂动脉瘤,76例在出血72 h内实施了治疗。术后对患者进行脑血管造影和临床随访。结果支架准确释放115例(97.5%),因为血管扭曲和痉挛失败植入支架1例,支架移位2例。实施单纯支架植入2例,采用微导管经支架网眼技术66例,支架后释放技术49例。术后即刻造影示动脉瘤完全栓塞87例(74.4%),次全栓塞30例(25.6%)。术中无动脉瘤破裂出血事件发生,术后症状性脑梗死3例,无症状性脑梗死5例。术后随访6～60个月,平均26.8个月,共随访到105例,复查1～5次脑血管造影,完全栓塞99例(84.6%),次全栓塞病例中11例(36.7%)存在血栓形成;9例(7.7%)瘤体复发,其中5例进行了再次治疗达到完全栓塞,术后所有患者均无再出血,除3例外,所有患者支架内无明显狭窄。结论 Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤安全、有效,仍需更长期的随访和多中心研究。

The Neuroform3 stent-assisted endovascular coil embolization for the treatment of intracranial wide-necked aneurysms: long-term follow-up results

Objective To evaluate the long-term efficacy of Neuroform3 stent-assisted endovascular coil embolization in treating intracranial wide-necked aneurysms.Methods During the period of 2007-2011,Neuroform3 stent-assisted endovascular coil embolization was carried out in 118 patients with intracranial wide-necked aneurysms.Of the 118 patients,ruptured aneurysm was seen in 86 and unruptured aneurysm was seen in 32.Neuroform3 stent-assisted endovascular coil embolization was carried out in 76 patients of ruptured aneurysm within 72 hours after the onset of bleeding.During the follow-up period,both clinical examination and cerebral angiography were employed to evaluate the therapeutic results.Results The Neuroform3 stent was successfully and accurately deployed in 115 cases(97.5%).During the whole procedure,the stent moved slightly in 2 cases,and failure of deployment occurred in 1 case because of the twist and spasm of the internal carotid artery.Pure stent deployment was adopted in 2 cases,and the microcatheter was introduced into the aneurysm by using the stent struts technique in 66 cases.The microcatheter was "jailed" between the arterial wall and the stent in 49 aneurysms.The angiography performed immediately after the treatment showed that total occlusion of the aneurysm was achieved in 87 cases(74.4%),subtotal occlusion of the aneurysm was obtained in 30 cases(25.6%).During the operation performance,no evident bleeding events due to the rupture of the aneurysms were observed.Postoperative symptomatic occurred in three cases and asymptomatic cerebral infarction was seen in five cases.A follow-up period ranged from 6 to 60 months was made(mean of 26.8 months),and a total of 105 patients were followed up with cerebral angiography which was performed one to five times.The results showed that complete occlusion of the aneurysms was obtained in 99 patients(84.6%),and thrombosis was found in 36.7%(n = 11) of patients with subtotal occlusion of the aneurysms.Recurrence of the aneurysms occurred in 9 cases(7.7%),and endovascular coil embolization was carried again in 5 cases.After the treatment,no rebleeding occurred in all patients,and except for three patients no in-stent stenosis was observed.Conclusion The Neuroform3 stent-assisted endovascular coil embolization is a safe and effective treatment for intracranial wide-necked aneurysms,but the multicenter clinical study is needed to further clarify its long-term efficacy.