应用Neuroform支架技术治疗颅内宽颈动脉瘤的疗效分析

目的 探讨和总结颅内宽颈动脉瘤应用Neuroform自膨式支架结合弹簧圈治疗的新技术，评价Neuroform自膨式支架的顺应性、结合弹簧圈治疗的有效性。方法 回顾性分析采用Neuroform自膨式支架结合弹簧圈新技术治疗的30例颅内宽颈动脉瘤患者的疗效，30例患者的平均动脉瘤大小为9．5mm。在微导丝导引下推送Neuroform支架组合体，跨骑动脉瘤颈释放支架，其中一期支架辅助弹簧圈治疗动脉瘤20例，二期支架结合弹簧圈栓塞动脉瘤10例。结果 30例患者中术中完全栓塞21例（70％），大部分栓塞9例（30％）。术后支架移位2例，血栓性栓塞1例。术后临床随访29例，仅1例遗留永久性轻偏瘫；21例术后6～12个月经数字减影血管造影显示，7例动脉瘤残留需行二次治疗，其中4例第2次达到了完全栓塞。结论 支架辅助弹簧圈栓塞新技术提高了颅内宽颈动脉瘤的近期疗效，但长期疗效尚有待临床及血管造影随访结果来证实。

Endovascular stent implantation in treatment of intracranial wide-necked aneurysms

Objective To evaluate the effectiveness and feasibility of treatment of intracranial wide-necked aneurysms with a new technique of Neuroform self-expanding stent combined with detachable coil. Methods A retrospective analysis of Thirty patients with intracranial wide-necked aneurysms, 14 males and 16 females, aged 48 (18~68), wide-necked aneurysms, underwent occlusion of aneurysms using Neuroform self-expanding stent combined with detachable coil. Results 21of the 30 aneurysms were completely occluded (70%)and 9 of the 30 aneurysms were incompletely occluded(30%)after initial coils embolization. Thromboembolic events were found in one case and migration of stent in two cases. Clinical follow-up performed in 29 patients showed that only one patient had permanent mild hemi-paralysis. Twenty-one patients were followed up for 6~12 months, 7 of which needed second treatment and 4 of which showed complete occlusion. Conclusion A flexible device, Neuroform self-expanding stent can be safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. The new technique of Neuroform stent combined with detachable coil increases the early outcome of intracranial wide-necked aneurysm.