Neuroform支架在颅内动脉瘤栓塞治疗中的应用

目的介绍Neuroforn支架治疗颅内宽颈及梭形动脉瘤的初步应用.方法8例患者(9个动脉瘤),男性3例,女性5例;年龄41～74岁.3例为颈内动脉宽颈动脉瘤,3例(4个)为椎动脉动脉瘤,2例为基底动脉顶端动脉瘤.股动脉穿刺后常规肝素化.3 m长的Transcend 0.014交换导丝在微导管的保护下送到载瘤动脉后,通过该导丝释放支架,或直接将预装好的支架系统在205 cm长的Transcend 0.014导丝导引下送到理想的位置后释放支架,在支架释放完毕后,根据具体情况做是否进一步用电解弹簧圈(GDC)填塞.术后维持肝素化24 h.对已经用弹簧圈填塞动脉瘤的病例口服6周阿司匹林,300 mg/d,抵克立得250 mg/d.之后阿司匹林300 mg/d,维持6个月.单纯支架置入病例肝素化后仅口服阿司匹林1个月,300mg/d.结果3例(2例颈内动脉及1例椎动脉动脉瘤)放置支架后用弹簧圈完全闭塞动脉瘤.2例(3个)椎动脉动脉瘤仅放置支架,其中1例椎动脉夹层动脉瘤在3个月后复查时用GDC完全栓塞动脉瘤腔.1例基底动脉顶端动脉瘤放置支架后动脉痉挛,患者无症状,4个月后复查动脉瘤腔明显减小,GDC完全填塞动脉瘤腔.另1例基底动脉顶端动脉瘤放置支架后用GDC部分填塞动脉瘤.1例后交通动脉瘤,在弹簧圈推出过程中支架移位,颈内动脉痉挛.术后常规抗凝,20 h后动脉瘤再次出血,患者因急性脑疝死亡.结论Neuroform因其质地柔软,很容易通过弯曲的颅内血管并释放,结合GDC的填塞,可使颅内宽颈动脉瘤得到治疗,同时支架本身也能使动脉瘤形态及血流动力发生变化.但由于过分柔软,其稳定性及支撑力较差.

Application of Neuroform stent in the treatment of intracranial aneurysm

OBJECTIVE: To introduce the application of Neuroform stent in the treatment of intracranianl wide neck aneurysm. METHODS: Eight patients (9 aneurysms), including 3 males and 5 females, aged from 41 to 74, were treated. Among the 9 aneurysms, there were 3 wide-neck aneurysms in internal carotid artery (ICA), 4 vertebral aneurysms (in 3 cases), and 2 basilar tip giant aneurysms. Heparinization were given for all procedures after femoral artery Seldinger's puncture. Stents were released through 3 m Transcend 0.014 guide wires, which were posited in the aneurysm-carry arteries first, or, through a 205 cm Transcend 0.014 guiding wire. Further coiling was selected for some cases. After the treatment 24 h heparinization were maintained. For coiling cases, aspirin (300 (mg/d) and ticlopiding (250 mg/d) were given at first 6 weeks, and aspirin (300 mg/d) was given following 6 months. For stent alone cases, only 1 month aspirin (300 mg/d) was given. RESULTS: In one ICA aneurysm, the stent moved to the bifurcation of ICA while a coil was pushed into the aneurysm lumen, and the ICA spasmed. Partial occlusion achieved in the aneurysm. The patient died due to bleeding of the aneurysm 20 h after anticoagulation treatment with heparin. One dissection aneurysm and 2 fusiform aneurysms (in bilateral vertebral arterys of one patient) were treated with stents only. The dissection aneurysm was completely occluded after 3 months. In 1 basilar artery (BA) tip giant aneurysm, the distal part of BA spasmed immediately after stenting. Complete occlusion was achieved with coils 4 months later. Another BA tip aneurysm was partially occluded after the stent was deployed. The other 3 aneurysms were completely embolized with the protection of the Neuroform stents. There is no further DSA follow-up of the cases. CONCLUSIONS: The Neuroform stent is easy to pass through the tortuous vessels. Combine with coils, it may be used in the treatment of wide neck aneurysms. However, it has the risk of migration because of the softness.