摘要
目的探讨和总结单纯支架植入治疗颅内宽颈囊性小动脉瘤的可行性、安全性和疗效。方法 2001年2月到2009年11月,采用单纯支架植入法治疗36例颅内宽颈囊性小动脉瘤。按临床Hunt&Hess分级,0级22例,Ⅰ级8例,Ⅱ级5例,Ⅲ级1例。动脉瘤直径为1.8～5.0mm,平均3.6mm。分别位于基底动脉(1例)、前交通动脉(1例)、后交通动脉(11例)、颈内动脉床突上段(18例)、脉络膜前动脉(4例)和大脑中动脉(1例)。采用DSA或MRA及改良MRS(modified rankin scale)评分进行影像和临床随访。结果 36例颅内宽颈囊性小动脉瘤患者共成功植入37枚支架。术后即刻造影显示1例动脉瘤完全不显影,2例血管迂曲度明显改变,3例明显对比剂滞留。对22例患者进行了影像学随访,其中20例采用DSA造影,2例采用增强MRA,平均随访时间为16个月(3～59个月)。动脉瘤完全愈合11例(50%),动脉瘤颈变窄伴动脉瘤体缩小9例(40%),单纯动脉瘤颈变窄1例(5%),单纯动脉瘤体缩小1例(5%)。临床随访除1例失访外,其余35例均无病情恶化或遗留永久神经功能缺失。术中、术后并发症有短暂脑缺血发作1例,血管痉挛3例,股动脉穿刺点血肿1例,颅内感染1例。结论对于传统血管内介入和开颅夹闭存在一定困难的颅内宽颈囊性小动脉瘤,单纯支架植入术是可供选择的治疗方法之一。近期疗效满意,远期疗效、安全性和疗效仍需大宗病例的验证。
Objective To discuss the feasibility,safety and efficacy of sole stenting technique for the treatment of small wide-necked saccular intracranial aneurysms.Methods Between February 2001 and November 2009,36 consecutive patients with small wide-necked saccular intracranial aneurysms （18 males and 18 females,aged 19-75 years,with a mean age of 52.3 years） were treated with stenting technique only.Of 36 patients,the Grade 0 of Hunt Hess classification was seen in 22,Grade Ⅰ in 8,Grade Ⅱ in 5 and Grade Ⅲ in 1.The aneurysmal diameter ranged from 1.8 mm to 5.0 mm,with a mean diameter of 3.6 mm.The aneurysms were located at the anterior communicating artery （n=1）,posterior communicating artery （n=11）,intradural paraclinoid internal carotid artery （n=18）,basilar artery （n=1）,anterior choroidal artery （n=4） or middle cerebral artery （n=1）.The clinical manifestations,the angiographic findings and the follow-up observations were analyzed and the results were evaluated by means of the Modified Rankin Scale,magnetic resonance angiography and digital subtraction angiography.Results Sole stenting treatment was performed in 36 patients with small wide-necked saccular intracranial aneurysms.A total of 37 stents were successfully delivered and deployed at the targeted location.Immediate post-procedural angiography showed that complete occlusion was obtained in one aneurysm,a sluggish intra-aneurysmal vortex motion in 3 aneurysms and a correction of the angle of the parent vessel in two cases,whereas no change was seen in the remaining 30 aneurysms.Angiographic follow-up was carried out in 22 of the 36 patients （61%）during a mean following-up period of 16 months （ranged from 3 to 59 months）.The follow-up angiography showed that the complete occlusion was seen in 11 cases,narrowed aneurysmal neck with shrinkage of the aneurysm in 9 cases,narrowed aneurysmal neck only in 1 case,and shrinkage of the aneurysm only in 1 case.All the patients remained neurological intact at the most recent clinica
出处
《介入放射学杂志》
CSCD
北大核心
2010年第6期429-434,共6页
Journal of Interventional Radiology
关键词
宽颈
囊性
小颅内动脉瘤
单纯支架
wide-necked saccular intracranial aneurysm
sole stenting treatment
