Neuroform自膨式支架结合弹簧圈栓塞颅内宽颈动脉瘤

摘要

Objective To evaluate the preliminary experience of the combined application of a serf-expanding neurovascular stent (Neuroform stent) and detachable coils in the management of intracranial wide-necked aneurysms.Methods Self-expandind neurovaseular stents and detachable coils were used in the treatment of 30 patients with total 31 intracranial widenecked aneurysms including cavernous segment ICA aneurysrns in 3, ophthalmic artery aneurysm in 3, PcomA in 20, AeomA in 2, MCAM1 in 1 ,MCA bifurcation in 1 ,and basilar trunk in 1.The Neuroform stents were deployed across the neck of aneurysm.The detachable coils were released to embolize the aneurysm through stent mesh.Results Thirty-one Neuroform stents were sueee- fully deployed in 30 patients.Four Neuroform Ⅱ stents were used, and twenty-seven Neurofom Ⅲ stents were used.Total occlu- sion was achieved in 9 patients, residual neck in 11 patients and partial occlusion in 11 patients.Two patients were rebleeding during the operations; In -stent thrombosis occurred in 2 patients; One patient had transient ischemic attacks after the operation.Twenty-eight patients recovered well but with one death, the other had paralysis.Twenty-eight patients were under clinical fol- lowed up form 1 to 32 months with an average of 11 months.There was no bleeding.Six patients were angiographically followed up for 6-12 months after the procedure.Among them, in-stent thrombosis occurred in 1 patient, and there was no change in other 5 aneurysms with neck remnant.Conclusion The Neuroform stent is technically feasible and can be safely used in intraeranial wide-necked aneurysms which are unsuitable for clipping.The long term effect still need to be further investigated.%目的 报道采用Neuroform自膨式支架结合弹簧圈治疗颅内宽颈动脉瘤,探讨该支架的特点及使用该支架的安全性、术中并发症、短中期疗效和应用前景.方法 采用Neuroform支架结合弹簧圈栓塞治疗30例31枚颅内宽颈动脉瘤.颈内动脉海绵窦段3枚,眼动脉3枚,后交通动脉20枚,前交通动脉2枚,大脑中动脉M1段1枚,大脑中动脉分又部1枚,基底动脉干1枚,其中1例患者为多发动脉瘤,绝对宽颈(瘤颈>4 mm)动脉瘤26枚,相对宽颈5枚,瘤颈瘤体闲均>0.7.结果 4枚采用Neuroform Ⅱ代自膨式支架结合弹簧圈栓塞治疗,其余均采用Neuroform Ⅲ代支架结合弹簧圈栓塞治疗.30例31枚支架均成功到位释放,1例多发动脉瘤患者置入2枚支架.9枚动脉瘤完全栓塞(100%),11枚几乎完全栓塞(95%～99%),11枚不完全栓塞(95%以下).2例术中出血;2例术中支架内血栓形成,其中1例术后遗留肢体偏瘫,另1例死亡;1例术中弹簧圈尾端从支架网孔突入颈内动脉,术后出现一过性脑缺血表现,其余患者均恢复良好出院.临床随访28例,随访期1～32个月,平均11个月,6例术后6～12个月血管造影随访,其中1例后交通动脉瘤患者同侧大脑前动脉闭塞,大脑中动脉主干血栓形成;另5例原有瘤颈残留者无变化.结论 在栓塞颅内宽颈动脉瘤时应用Neuroform自膨式支架结合弹簧圈技术,使弹簧圈无法突入载瘤动脉,可提高栓塞致密度,安全疗效好.