支架辅助机械解脱弹簧圈栓塞治疗Willis环周围宽颈动脉瘤的临床应用

摘要

目的 探讨应用Solitaire AB支架辅助AxiumTM机械解脱弹簧圈栓塞治疗Willis环周围宽颈动脉瘤的技术、方法及疗效.方法 采用Seldinger技术,对21例Willis环周围宽颈动脉瘤应用Solitaire AB支架辅助AxiumTM机械解脱弹簧圈栓塞治疗,9例通过支架网孔置入微导管行动脉瘤栓塞,支架解脱;对12例载瘤动脉迂曲导管不易进入网孔者,采用先将支架跨过动脉瘤两端,将微导管置于动脉瘤内距瘤底部1/3～1/2处,弹簧圈部分释放后,再释放支架进行动脉瘤栓塞,解脱支架.结果 21例患者所有支架、弹簧圈置入顺利,释放位置满意,技术成功率100%.21枚动脉瘤完全栓塞16枚,占76.2%;大部栓塞5枚,占24.8%.术后患者恢复良好,随访3～6个月,未发生出血或脑血栓形成.结论 联合使用Solitaire AB支架辅助AxiumTM机械解脱弹簧圈栓塞治疗Willis环周围宽颈动脉瘤是一种安全、有效的方法,但其长期疗效仍需进一步观察.%Objective To discuss the technique, manipulation skill ancl efficacy of stent-assisted mechanically-detachable coil emholization for the treatment of wide-necked aneuiysms located around the Willis circle. Methods Twenty-one patients with wide-necked aneurysms around the Willis circle were treated with embolization therapy by using Solitaire AB stent-assisted mechanically-detachahle Axium TM oil through seldinger technique. Of the total 21 patients, 9 were implanted with stent at first, which was followed by the insertion of a microcatheter through the stent mesh for emholization, then the stent was detached. For the remaining 12 cases who showed a tortuous parent artery which made pushing the catheter into the stent mesh difficult, the stent was first placed crossing over the both ends of the aneurysm, then the microcatheter was placed within the aneurysm slightly apart from the bottom of the aneurysm. The stent was then detached for embolization after the coil was partially released. Results All the stents and coils were implanted in the right place. The operation was successfully completed in all patients. Complete occlusion of aneurysmal cavity was obtained in 16 cases(76.2％) . while larger part of aneurysmal cavity was occluded in 5 cases (24.8％).After the procedure, all the patients recovered well. Neither rebleeding nor thromhosis-related sympotoms occurrecl during a follow-up period of 3-6 months. Conclusion For the treatment of wicle-necked aneurysms located around the Willis circle, endovascular embolization by using Solitaire AB stent together with mechanically-detachable Axium TM coil is a safe and effective method. However, its long-term effect needs to be further ohserved. (J Intervent Radiol, 2011,20 : 429-432)