LVIS支架联合弹簧圈栓塞急性期颅内破裂宽颈动脉瘤的临床疗效

摘要

Objective To investigate the safety and efficacy of LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase.Methods From May 2014 to August 2017,the clinical and imaging data of 56 patients with ruptured wide-necked intracranial aneurysm treated with LVIS stents for acute phase assisted embolization at the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.All patients were treated with LVIS stent combined with coil embolization.Immediate postoperative angiography,six months after procedure,and follow-up imaging were evaluated by Raymond grade (RS grade).The clinical follow-up results were evaluated by the modified Rankin Scale (mRS) score.Results LVIS stent combined with coil embolization was performed in 56 patients with 60 aneurysms in this group.The success rate of stent release was 100％.Immediate angiography after procedure showed that the complete embolization rate of aneurysms was 80.0％ (48/60),the near complete embolization rate was 13.3 ％ (8/60),and the incomplete embolization rate was 6.7％ (4/60).Postoperative follow-up angiography at 6 monthrevealed that the complete embolization rate of aneurysms was 87.8％ (36/41),nearly complete embolization rate was 7.3％ (3/41),incomplete embolization rate was 4.9％ (2/41).Postoperative follow-up angiography at 12 months revealed that the complete embolization rate of aneurysms was 83.0％ (39/47),and near complete embolization rate was 12.8％ (6/47),and incomplete embolization rate was 4.3％ (2/47).Of the 56 patients,49 were followed up clinically and 7 were lost to follow up.The average follow-up time was 13 ± 4 months.The clinical follow-up showed that the good prognosis (mRS score 0-2) rate was 87.8％ (43/49).Intraoperative complications occurred in 7 cases,5 were intraoperative parent artery thrombosis and 2 were intraoperative aneurysm rupture.Conclusions LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase has good efficacy and safety.Its long-term efficacy remains to be confirmed by long-term follow-up.%目的 探讨LVIS支架联合弹簧圈栓塞急性期颅内破裂宽颈动脉瘤的安全性和有效性.方法 回顾性分析西南医科大学附属医院神经外科2014年5月至2017年8月收治的56例颅内破裂宽颈动脉瘤患者经LVIS支架于急性期治疗的临床资料及影像学资料,均采用LVIS支架进行治疗,术后即刻、半年及1年随访造影结果采用Raymond分级(RS分级)进行评估,临床随访结果采用改良Rankin量表(mRS)进行评分.结果 本组56例患者中,共对60个动脉瘤行LVIS支架置入,支架展开成功率为100％,术后即刻造影显示动脉瘤完全栓塞率为80.0％ (48/60),近全栓塞率为13.3％ (8/60),不全栓塞率为6.7％(4/60);术后半年随访造影显示动脉瘤完全栓塞率为87.8％(36/41),近全栓塞率为7.3％(3/41),不全栓塞率为4.9％ (2/41);术后1年随访造影显示动脉瘤完全栓塞率为83.0％(39/47),近全栓塞率为12.8％(6/47),不全栓塞率为4.3％ (2/47).56例患者中有49例获得临床随访,失访7例,平均随访时间为(13±4)个月,临床随访显示预后良好(mRS评分0～2分)率为87.8％ (43/49).术中并发症7例,分别为术中载瘤动脉内血栓形成5例、术中动脉瘤破裂2例.结论 LVIS支架联合弹簧圈栓塞急性期颅内破裂宽颈动脉瘤具有良好的有效性及安全性,其远期疗效有待长期随访进一步证实.