支架辅助栓塞破裂性前交通宽颈动脉瘤

目的 探讨支架辅助栓塞前交通宽颈动脉瘤的术前评估、支架植入策略、治疗效果.方法 回顾分析采用支架结合弹簧圈治疗的21例前交通宽颈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 21例动脉瘤均成功植入支架,其中Neuroform支架19枚、LEO支架2枚.12例支架远端位于同侧A2段、5例支架远端越过前交通植入对侧A2段、4例位于动脉瘤内.术后即刻致密栓塞18例;大部分栓塞2例;部分栓塞1例.术中动脉瘤破裂1例,经继续栓塞后出血得到控制.平均8.7个月后DSA随访12例,MRA随访4例,显示1例动脉瘤再通.结论 术前应根据动脉瘤及前交通动脉的解剖形态和功能制定支架植入策略.支架辅助栓塞前交通宽颈动脉瘤技术安全可行,动脉瘤致密栓塞率高.支架的长期疗效需进一步随访观察.

Stent-assisted coiling for ruptured wide-necked anterior communicating artery aneurysms:a single-center experience

Objective To evaluate the efficacy of stent-assisted coiling for ruptured wide-necked anterior communicating artery aneurysms and its related factors. Methods A retrospective review of 21 patients with ruptured wide-necked anterior communicating artery aneurysms received stent-assisted coiling therapy was conducted,including aneurysm morphology,procedures,angiographic results and clinical outcomes.Results Stent placement was technically suceesful in all of the aneurysms.Total occlusion(＞95%) was achieved immediately in 18 cases (85.7%), nearly complete occlusion (90%～95%) in 2 cases (9.5%) and partial occlusion (＜90% ) in one case (4.7%).Procedure related complication occurred in one patient(aneurysm perforation,4.7%),which was secured by subsequent coiling.Angiographic follow-up in 16 cases for 8.7 months showed one recanalization(6.2%).Conclusion Application of stent-assisted embolization seems to facilitate endovascular treatment for ruptured wide-necked AcomA aneurysm.The aneurysms morphology and AcomA functional anatomy should be considered for stent implantation strategy.