44例支架辅助弹簧圈栓塞颅内动脉瘤临床分析

Clinical effect of stent-assisted coil embolization in treatment of intracranial aneurysms: An analysis of 44 cases

摘要:

目的 探讨支架辅助弹簧圈栓塞治疗颅内动脉瘤的安全性及有效性。方法 收集我科支架辅助弹簧圈栓塞治疗颅内动脉瘤的患者44例，对其临床资料、手术方法、并发症及预后进行回顾性分析分析。Raymond分级评价动脉瘤即刻栓塞程度，术后6个月改良Rankin量表（modified Rankin scale，mRS）评估疗效。结果 44例患者共51个动脉瘤，破裂动脉瘤28个（54.90%），未破裂动脉瘤23（45.1%）个，均为宽颈动脉瘤。术中使用支架类型包括LVIS、LVIS JR.、Enterprise、LEO支架。所有患者支架完全释放。Ⅰ级栓塞率74.5%。术中支架内血栓形成7例（15.90%），发生出血性并发症4例（9.09%）。死亡3例（6.82%）。术后6月随访结局良好81.81%（mRS评分0-2分）。结论 支架辅助栓塞颅内动脉瘤技术对于治疗复杂动脉瘤相对安全、有效。改良术中操作、针对患者采取个体化抗凝治疗是避免并发症发生的主要措施。

Abstract:

Objective To investigate the clinical effect and safety of stent-assisted coil embolization in the treatment of intracranial aneurysms.Methods A retrospective analysis was performed for the clinical data, surgical approach, complications, and prognosis of 44 patients with intracranial aneurysms who were treated with stent-assisted coil embolization in our department. The degree of immediate aneurysm embolization was evaluated according to the Raymond classification, and the modified Rankin scale (mRS) was used to evaluate clinical outcome at 6 months after surgery. Results There were 51 aneurysms in total in 44 patients. There were 28 ruptured aneurysms (54.90%) and 23 unruptured aneurysms (45.1%), and all of them were wide-necked aneurysms. The stents used in surgery included LVIS, LVIS JR., Enterprise, and LEO stents. The stent was completely released in all patients. The rate of grade I embolization was 74.5%. Of all patients, 7 (15.90%) experienced thrombosis in stent during surgery and 4 (9.09%) experienced bleeding complications. Three patients died, resulting in a mortality rate of 6.82%. At 6 months after surgery, 81.81% of the patients had a good clinical outcome (with an mRS score of 0-2).Conclusions Stent-assisted coil embolization is safe and effective in the treatment of complex aneurysms. Modification of intraoperative procedure and individualized anticoagulant therapy for patients are the main measures for reducing complications.