摘要
目的评估支架辅助弹簧圈栓塞在血泡样动脉瘤治疗中的作用。方法回顾性分析8例采用支架辅助弹簧圈栓塞治疗的颈内动脉血泡样动脉瘤的临床特点、治疗过程及脑血管造影结果及随访结果。本组8例中,成功实施支架辅助弹簧圈栓塞术5例。2例因动脉瘤体积过小无法进一步实施弹簧圈栓塞,以单纯支架治疗。1例患者在成功释放支架后填塞弹簧圈过程中发生动脉瘤破裂,改行颈内动脉闭塞术。结果患者出院时改良Rankin评分为1分4例,2分1例,3分1例,2例患者因术后再出血死亡。术后9～36个月(平均21.5个月)的临床随访结果提示4例患者改良Rankin评分为0分,1例1分,1例2分。所有患者均接受影像学随访,证实动脉瘤影像学复发3例,均接受再次血管内栓塞治疗。结论支架辅助的弹簧圈栓塞术是治疗颈内动脉血泡样动脉瘤血泡样动脉瘤的可行方法之一。此方法用于急性期治疗有较高的安全性,可降低急性期病死率,应用多支架技术或使用新型低孔率支架辅助栓塞可能会进一步降低再出血和复发的风险。
Objective Blood blister-like aneurysms （BBAs） are tiny aneurysms arising from the non-branching sites of the anterior wall of the supra-clinoid segment of internal carotid artery. These aneurysms are quite dangerous because of the high risk of recurrent bleeding associated with their fragile neck. The optimal treatment for the BBAs is still controversial. This paper aims to evaluate the application of stent-assisted coil embolization in the treatment of BBAs. Methods A retrospective review of the aneurysm database in our institution identified 8 patients carrying BBAs treated by stent-assisted coil embolization. The clinical characteristics, procedural data, angiographic findings, and follow-up results were analyzed and evaluated. Results Of the eight patients, stent-assisted coil embolization was successfully performed in 5 （62.5%）. Sole stent deployment was employed in two cases （25%） because the aneurysm was too small to be occluded with coils. During the procedure rupture of the aneurysm occurred in one patient when the stent was successfully delivered and the coil was used with an attempt to fill the aneurysmal cavity, and, therefore, the occlusion of internal carotid artery had to be carried out in this patient. The modified Rankin Scale score at the time of discharge in the alive patients was 1 （n = 4）, 2 （n = 1） or 3 （n = 1）. Two patients died due to post-operative bleeding （25%）. The modified Rankin Scale score at 9-36 months （mean 21.5 months） after the treatment was 0 in 4 patients, 1 in 1 patient, and 2 in 1 patient. Angiographic checkup was made in all patients during the following-up period, and reoccurrence of the aneurysm was observed in three cases, who had to accept endovascular treatment once more. Conclusion Stent-assisted coil embolization is one of the feasible methods for the treatment of BBAs. It is quite safe to employ this technique in the acute stage of BBAs and,moreover, this therapy can markedly reduce the mortality. It is possible that the application of multiple stents or newly-developed low porosity stents may further reduce the risk of re-bleeding or reoccurrence.
出处
《介入放射学杂志》
CSCD
北大核心
2010年第5期349-353,共5页
Journal of Interventional Radiology
基金
上海市科委重点项目(编号074119506)
关键词
动脉瘤
颈内动脉
血管内治疗
支架
aneurysm
internal carotid artery
endovascular therapy
stent
