[1]程吉勇,洪波,许奕,等.单纯支架治疗颅内宽颈囊性小动脉瘤的临床疗效分析[J].介入放射学杂志,2010,(06):429.
 CHENG Jiyong,HONG Bo,XU Yi,et al.Sole stenting treatment for small wide-necked saccular intracranial aneurysms :a clinical therapeutic analysis[J].journal interventional radiology,2010,(06):429.
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单纯支架治疗颅内宽颈囊性小动脉瘤的临床疗效分析()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2010年06期
页码:
429
栏目:
神经介入
出版日期:
2010-06-15

文章信息/Info

Title:
Sole stenting treatment for small wide-necked saccular intracranial aneurysms :a clinical therapeutic analysis
作者:
程吉勇洪波许奕
200433上海第二军医大学长海医院神经外科
Author(s):
CHENG Ji-yongHONG Bo XU Yi HUANG Qing-haiYANG Peng-feiZHAO Wen-yuanLIU Jian-min
the Affiliated Changhai Hospital,Second Military Medical University,Shanghai200433,China
关键词:
宽颈囊性小颅内动脉瘤单纯支架
分类号:
R743.4
文献标志码:
A
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。

参考文献/References:

[1]Ishibashi T,Murayama Y,Urashima M,et al.Unruptured intracranial aneurysms incidence of rupture and risk factors[J].stroke,2009,40:313-316.
[2]Zenteno MA,Murillo-Bonilla LM,Guinto G,et al.Sole stenting bypass for the treatment of vertebral artery aneurysms :technical case report[J].Neurosurgery,2005,57(1Suppl ):E208.
[3]Juszkat R,Nowak S,Wieloch M,et al.Complete obliteration of a basilar artery aneurysm after insertion of a self-expandable leo stent into the basilar artery without coil embolization[J].Korean J Radiol,2008,9:371-374.
[4]Zenteno MA,Santos-Franco JA,Freitas-Modenesi JM,et al.Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of20patients[J].J Neurosurg,2008,108:1104-1118.
[5]Benndorf G,Herbon U,Sollmann WP ,et al.Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement :case report[J].AJNR,2001,22:1844-1848.
[6]Zhao WY,Krings T,Alvarez H,et al.Management of spontaneous haemorrhagic intracranial vertebrobasilar dissection:review of21consecutive cases[J].Acta Neurochir(Wien),2007,149:585-596.
[7]Linn FH,Rinkel GJ ,Algra A,et al.Incidence of subarachnoid hemorrhage:role of region year and rate of computed tomography:a metaanalysis[J].Stroke,1996,27:625-629.
[8]Molyneux A,Kerr R,Stratton I,et al.International subarachnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovas-cular coiling in2143patients with ruptured intracranial aneurysms :a randomised trial[J].Lancet2002,360:1267-1274.
[9]Cloft HJ ,Joseph GJ ,Tong FC,et al.Use of three-dimensional Guglielmi detachable coils in the treatment of wide-necked cerebral aneurysms [J].AJNR,2000,21:1312-1314.
[10]Baldi S,Mounayer C,Piotin M,et al.Balloon-assisted coil placement in wide-neck bifurcation aneurysms by use of a new,compliant balloon microcatheter[J].AJNR,2003,24:1222-1225.
[11]刘建民,洪波,许奕,等.血管内支架治疗颅内动脉瘤[J].介入放射学杂志,2001,10:195-198.
[12]黄清海,刘建民,许奕,等.难治性颅内动脉瘤血管内支架治疗的初步结果[J].介入放射学杂志,2004,4:297-300.
[13]Huang Q,Xu Y,Hong B,et al.Stent-assisted embolization of wide-neck anterior communicating artery aneurysms :review of21consecutive cases[J].AJNR,2009,30:1502-1506.
[14]Wakhloo AK,Schellhammer F,de Vries J,et al.Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms :An experimental study in a canine model[J].AJNR,1994,15:493-502.
[15]张鑫,刘建民,黄清海.脑动脉瘤血流动力学数值模拟研究及其临床意义[J].介入放射学杂志,2008,17:898-902.
[16]Liou TM,Liou SN,Chu KL.Intra-aneurysmal flow with helix and mesh stent placement across side-wall aneurysm pore of a straight parent vessel[J].J Biomech Eng,2004,126:36-43.
[17]Liu J,Zhao W,Zhang X,et al.Pathology of stented common carotid aneurysm in dogs comparison between stenting and stent-assisted coiling[J].Intervent Neuroradiol,2005,11:333-340.
[18]Doerfler A,Wanke I,Egelhof T,et al.Double-stent method:therapeutic alternative for small wide-necked aneurysms.Technical note[J].J Neurosurg,2004,100:150-154.
[19]Liou TM,Li YC.Effects of stent porosity on hemodynamics in a sidewall aneurysm model[J].J Biomech,2008,41:1174-1183.
[20]Wiebers DO,Whisnant JP,Huston J,et al.Unruptured intracranial aneurysms :natural history,clinical outcome ,and risks of surgical and endovascular treatment [J].Lancet,2003,362:103-110.
[21]Morita A,Fujiwara S,Hashi K,et al.Risk of rupture associated with intact cerebral aneurysms in the Japanese population:a systematic review of the literature from Japan[J].J Neurosurg,2005,102:601-606.
[22]Otawara Y,Ogasawara K,Kubo Y,et al.Anxiety before and after surgical repair in patients with asymptomatic unruptured intracranial aneurysm[J].Surg Neurol,2004,62:28-31.
[23]Hong B,Patel NV,Gounis MJ ,et al.Semi-jailing technique for coil embolization of complex,wide-necked intracranial aneurysms [J].Neurosurgery,2009,65:1131-1139.
[24]Brinjikji W,Lanzino G,Cloft HJ ,et al.Endovascular treatment of very small(3mm or smaller)intracranial aneurysms :report of a consecutive series and a meta-analysis[J].Stroke,2010,41:116-121.
[25]Im SH,Han MH,Kwon OK,et al.Endovascular coil embolization of435small asymptomatic unruptured intracranial aneurysms :procedural morbidity and patient outcome [J].AJNR,2009,30:79-84.
[26]Zenteno M,Modenesi Freitas JM,Aburto-Murrieta Y,et al.Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms [J].Surg Neurol,2006,66:603-610.
[27]Turk AS.Niemann DB.Ahmed A,et al.Use of self-expanding stents in distal small cerebral vessels[J].AJNR,2007,28:533-536.
[28]Ionita CN,Paciorek AM,Dohatcu A,et al.The asymmetric vascular stent :efficacy in a rabbit aneurysm model[J].Stroke,2009,40:959-965.
[29]Marotta TR,Gunnarsson T,Penn I,et al.A novel endovascular clip system for the treatment of intracranial aneurysms :technology,concept ,and initial experimental results.Laboratory inves tigation[J].J Neurosurg,2008,108:1230-1240.
[30]Molyneux AJ ,Kerr RS,Yu LM,et al.International subara-chnoid aneurysm trial(ISAT)of neurosurgical clipping versus endovascular coiling in2143patients with ruptured intracranial aneurysms :a randomised comparison of effects on survival,dependency,seizures,rebleeding,subgroups,and aneurysm occlusion[J].Lancet,2005,366:809-817.
[31]Lopes D,Sani S.Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent [J].Neurosurgery,2005,56:E416.
[32]Lylyk P,Ferrario A,Pasbon B,et al.Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms [J].J Neurosurg,2005,102:235-241.
[33]Johnston SC,Dowd CF,Higashida RT,et al.Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms :the Cerebral Aneurysm Rerupture after Treatment (CARAT)study[J].Stroke,2008,39:120-125.
[34]Suzuki S,Kurata A,Ohmomo T,et al.Endovascular surgery for very small ruptured intracranial aneurysms Technical note[J].J Neurosurg,2006,105:777-780.
[35]Katsaridis V,Papagiannaki C,Violaris C.Embolization of acutely ruptured and unruptured wide-necked cerebral aneurysms using the neuroform2stent without pretreatment with antiplatelets:a single center experience[J].AJNR,2006,27:1123-1128.
[36]Lanzino G,Kanaan Y,Perrini P,et al.Emerging concepts in the treatment of intracranial aneurysms :stents,coated coils,and liquid embolic agents[J].Neurosurgery,2005,57:449-459.

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备注/Memo

备注/Memo:
收稿日期:2010-01-18
更新日期/Last Update: 2010-06-15