Willis覆膜支架治疗颅内段颈内动脉复杂性病变的临床应用

摘要

目的 评价Willis覆膜支架治疗颅内段颈内动脉复杂性病变的安全性和有效性.方法 回顾性分析2015年7月~2017年1月14例颅内段颈内动脉复杂性病变患者接受Willis覆膜支架治疗的病例资料.术后随访3~18个月复查DSA和临床观察结果,收集最初及最终造影结果、病死率、致残率及临床结果等数据.结果 14例患者共成功置入Willis覆膜支架15枚,其中血泡样动脉瘤8例,假性动脉瘤3例,多发动脉瘤1例,大动脉瘤2例,技术成功率100%.Willis覆膜支架释放部位C7段3枚,C6段8枚,C5段2枚,C4段2枚;支架植入后即时造影显示病变完全消失10例,内漏4例,经球囊扩张后2例内漏消失,1例仍存在微小内漏,1例再植入1枚支架后病变完全不显影.支架覆盖眼动脉2例,脉络膜前动脉1例,患者无明显神经系统症状.术后3~12个月随访复查DSA显示载瘤动脉通畅13例,轻度狭窄1例;病变完全不显影13例,1例复发.临床随3~18个月,mRS评分0分12例,1分2例,存活患者无新发神经功能缺失.结论 Willis覆膜支架治疗颅内段颈内动脉复杂性血管病变具有良好的安全性和短中期临床结果.%Objective To evaluate the safety and efficacy of Willis covered stent implantation for treating complex vascular diseases in the distal internal carotid artery. Methods 14 patients with complex vascular diseases of the distal internal carotid ar-teries were treated with 15 Willis covered stents from July 2015 through January 2017. Clinical records including technical success, initial and final digital subtraction angiography (DSA) results, mortality, morbidity and clinical outcome within 3~18 months after treatment were retrospectively analyzed. Results The 14 vascular diseases of the distal internal carotid arteries included blood blis-ter-like aneurysms (8), pseudoaneurysms (3), multiple aneurysms (1), and large wide-necked aneurysms (2). The release sites of Willis covered stents were C7 (3), C6 (8), C5 (2), and C4 (2) segments of the internal carotid arteries. The technical success rate was 100%. In 10 patients, angiography performed immediately after stent release showed complete disappearance of the aneurysm and the parent arteries remained patent. Endoleak was observed in 4 patients, which resolved completely (2) or partially with minor leak (1) after balloon dilatation . Another stent was implanted to eliminate the endoleak on the fourth patient . Occlusion of the ophthalmic artery (2) and anterior choroidal artery (1) occurred after stent implantation with no obvious neurologic symptoms. There were no significant procedural events during the perioperative period. No new neurological deficits were observed on follow-up with mRS score of 0 in 12 patients and 1 in 2 patients. Postoperative DSA showed patent(13) or mildly stenotic (1) parent arteries, completely occluded (13) or recurrent (1) aneurysms. Conclusion Willis covered stent implantation is safe and effective for treating complex vascular dis-eases in the distal internal carotid artery with good short and mid-term outcomes .