LVIS支架在辅助弹簧圈栓塞颅内宽颈动脉瘤的应用分析(1)
摘 要:目的 通过分析LVIS支架在辅助弹簧圈栓塞颅内宽颈动脉瘤的临床病例,探讨其有效性及安全性。方法 收集本院神经外科2014年9月~2015年9月应用LVIS支架栓塞颅内宽颈动脉瘤22例,根据Raymond分级评价术中动脉瘤填塞程度,再根据格拉斯哥预后评分评估其疗效。结果 22例宽颈动脉瘤患者均成功施行LVIS支架辅助介入栓塞术,术后即刻Raymond Ⅰ级栓塞,有效栓塞率为100.00%。缺血并发症2例(9.10%),随访6~24个月,预后良好组有19例(86.40%)。结论 应用LVIS支架在辅助弹簧圈栓塞颅内宽颈动脉瘤是安全有效的,短期随访效果佳,长期疗效有待进一步随访。术后出血并发症未见增加,术中、术后缺血发生率相应增加,与支架金属覆盖率高、展开位置不理想、贴壁不良有关。
关键词:颅内宽颈动脉瘤;LVIS支架;介入栓塞
中图分类号:R651.12 文献标识码:A DOI:10.3969/j.issn.1006-1959.2018.03.025
, http://www.100md.com
文章编号:1006-1959(2018)03-0081-04
Abstract:Objective To evaluate the efficacy and safety of LVIS stent in embolization of intracranial wide-necked aneurysms with coils.Methods From September 2014 to September 2015,22 cases of intracranial wide-necked aneurysms were embolized with LVIS stents.According to Raymond grading evaluation intraoperative aneurysm filling degree,and then according to Glasgow prognostic score to assess its efficacy.Results 22 patients with wide carotid aneurysm were successfully treated with Lvis stent-assisted interventional embolization.Raymond Ⅰ grade embolization was performed immediately after operation.The effective embolization rate was 100.00%.The ischemic complications occurred in 2 cases with(9.10%).The follow-up was 6~24 months,good prognosis group,19 cases (86.40%).Conclusion Lvis is safe and effective in stent assisted coil embolization of intracranial aneurysms,short-term follow-up effect is quite satisfying while long-term effect needs further follow-up.Postoperative bleeding complications were increased,intraoperative,postoperative ischemia rate increased because of the high rate of metal coverage of stent expansion,the location is not ideal and dysphasic adhesion.
, 百拇医药
Key words:Intracranial wide-necked aneurysms;LVIS stents;Interventional embolization
顱内动脉瘤为发生在颅内动脉血管壁的异常膨出,各年龄段均可发病,好发年龄段为40~60岁,女性多于男性,好发于脑底动脉环(Willis环)上,未破裂动脉瘤患者多是查体发现;动脉瘤破裂引起急性自发性蛛网膜下腔出血(aSAH),为致死率、致残率极高的临床急症。颅内宽颈动脉瘤是指瘤颈宽度≥4 mm或者动脉瘤颈体比大于1:2的动脉瘤,因术中弹簧圈容易脱出、移位、瘤颈残留等问题,一直以来是动脉瘤治疗的难点。随着介入治疗技术成熟,宽颈动脉瘤的治疗策略从填塞瘤腔变为重建载瘤动脉血流,因此高金属覆盖率的LVIS支架成为越来越多神经介入医师治疗宽颈动脉瘤的选择。本研究回顾性分析本院神经外科应用LVIS支架辅助弹簧圈栓塞22例颅内宽颈动脉瘤的临床资料,对其有效性、安全性报道如下。
1资料与方法
, 百拇医药
1.1一般资料 回顾性分析本院神经外科2014年9月~2015年9月应用LVIS支架辅助栓塞的22例颅内宽颈动脉瘤患者的临床资料。其中男性9例,女13例;年龄30~72岁,平均年龄(55.2±12.4)岁。4例为未破裂动脉瘤患者,入院时均通过头部CTA或MRA发现动脉瘤存在。18例破裂动脉瘤头颅CT检查均为蛛网膜下腔出血(SAH),其中FISH分级2级13例,FISH分级3级5例。本组所有病例均经DSA全脑血管造影证实动脉瘤位置及大小,其中20例位于前循环:眼动脉段动脉瘤3例,床突段动脉瘤4例,后交通动脉瘤9例,前交通动脉瘤2例,大脑中动脉分叉处动脉瘤2例;2例位于后循环:小脑上动脉动脉瘤1例,基底动脉顶端动脉瘤1例。动脉瘤直径1.8~12.6 mm,平均直径(6.7±3.0)mm。
1.2纳入与排除标准 纳入标准:①行动脉瘤支架辅助介入栓塞术,术中使用至少一枚LVIS支架;②拥有完整的术前、术中以及术后随访资料;③瘤颈宽度≥4 mm或者动脉瘤颈体比>1∶2;患者加家属知情同意。排除标准:①动脉瘤直径>15 mm;②夹层动脉瘤;③对肝素、阿司匹林及氯吡格雷等药物禁忌。, 百拇医药(方力 张晓冬 郭宗铎 朱继 孙晓川 唐文渊)
关键词:颅内宽颈动脉瘤;LVIS支架;介入栓塞
中图分类号:R651.12 文献标识码:A DOI:10.3969/j.issn.1006-1959.2018.03.025
, http://www.100md.com
文章编号:1006-1959(2018)03-0081-04
Abstract:Objective To evaluate the efficacy and safety of LVIS stent in embolization of intracranial wide-necked aneurysms with coils.Methods From September 2014 to September 2015,22 cases of intracranial wide-necked aneurysms were embolized with LVIS stents.According to Raymond grading evaluation intraoperative aneurysm filling degree,and then according to Glasgow prognostic score to assess its efficacy.Results 22 patients with wide carotid aneurysm were successfully treated with Lvis stent-assisted interventional embolization.Raymond Ⅰ grade embolization was performed immediately after operation.The effective embolization rate was 100.00%.The ischemic complications occurred in 2 cases with(9.10%).The follow-up was 6~24 months,good prognosis group,19 cases (86.40%).Conclusion Lvis is safe and effective in stent assisted coil embolization of intracranial aneurysms,short-term follow-up effect is quite satisfying while long-term effect needs further follow-up.Postoperative bleeding complications were increased,intraoperative,postoperative ischemia rate increased because of the high rate of metal coverage of stent expansion,the location is not ideal and dysphasic adhesion.
, 百拇医药
Key words:Intracranial wide-necked aneurysms;LVIS stents;Interventional embolization
顱内动脉瘤为发生在颅内动脉血管壁的异常膨出,各年龄段均可发病,好发年龄段为40~60岁,女性多于男性,好发于脑底动脉环(Willis环)上,未破裂动脉瘤患者多是查体发现;动脉瘤破裂引起急性自发性蛛网膜下腔出血(aSAH),为致死率、致残率极高的临床急症。颅内宽颈动脉瘤是指瘤颈宽度≥4 mm或者动脉瘤颈体比大于1:2的动脉瘤,因术中弹簧圈容易脱出、移位、瘤颈残留等问题,一直以来是动脉瘤治疗的难点。随着介入治疗技术成熟,宽颈动脉瘤的治疗策略从填塞瘤腔变为重建载瘤动脉血流,因此高金属覆盖率的LVIS支架成为越来越多神经介入医师治疗宽颈动脉瘤的选择。本研究回顾性分析本院神经外科应用LVIS支架辅助弹簧圈栓塞22例颅内宽颈动脉瘤的临床资料,对其有效性、安全性报道如下。
1资料与方法
, 百拇医药
1.1一般资料 回顾性分析本院神经外科2014年9月~2015年9月应用LVIS支架辅助栓塞的22例颅内宽颈动脉瘤患者的临床资料。其中男性9例,女13例;年龄30~72岁,平均年龄(55.2±12.4)岁。4例为未破裂动脉瘤患者,入院时均通过头部CTA或MRA发现动脉瘤存在。18例破裂动脉瘤头颅CT检查均为蛛网膜下腔出血(SAH),其中FISH分级2级13例,FISH分级3级5例。本组所有病例均经DSA全脑血管造影证实动脉瘤位置及大小,其中20例位于前循环:眼动脉段动脉瘤3例,床突段动脉瘤4例,后交通动脉瘤9例,前交通动脉瘤2例,大脑中动脉分叉处动脉瘤2例;2例位于后循环:小脑上动脉动脉瘤1例,基底动脉顶端动脉瘤1例。动脉瘤直径1.8~12.6 mm,平均直径(6.7±3.0)mm。
1.2纳入与排除标准 纳入标准:①行动脉瘤支架辅助介入栓塞术,术中使用至少一枚LVIS支架;②拥有完整的术前、术中以及术后随访资料;③瘤颈宽度≥4 mm或者动脉瘤颈体比>1∶2;患者加家属知情同意。排除标准:①动脉瘤直径>15 mm;②夹层动脉瘤;③对肝素、阿司匹林及氯吡格雷等药物禁忌。, 百拇医药(方力 张晓冬 郭宗铎 朱继 孙晓川 唐文渊)