LVIS支架辅助栓塞颅内破裂动脉瘤

LVIS stent-assisted embolization of ruptured intracranial aneurysm

摘要:

目的 探讨LVIS支架辅助栓塞颅内破裂动脉瘤的安全性和有效性。方法 回顾性分析2016年1月—2019年6月中山市人民医院脑血管介入科使用LVIS支架辅助栓塞颅内破裂动脉瘤118例，分析临床资料、栓塞率及并发症等情况。结果 118例颅内破裂动脉瘤均成功栓塞。术后即刻栓塞结果：RaymondⅠ级栓塞82例（69.5%），Ⅱ级栓塞29例（24.6%），Ⅲ级栓塞7例（5.9%）。术中LVIS支架完全打开116例（98.3%），未完全打开2例（1.7%）。术中形成脑血栓6例（5.1%），其中3例及时给予替罗非班治疗后消失，3例用药后仍有脑血栓及脑梗死症状。术后发生血栓事件2例（1.7%），经过积极治疗后1例遗留有神经功能缺损症状。术后随访6~12个月，动脉瘤复发6例（5.1%），支架内狭窄5例（4.2%），未发生再出血，疗效良好（mRS评分0~2分）102例（86.4%）、疗效不良16例（13.6%）。结论 LVIS支架辅助栓塞颅内破裂动脉瘤安全、可行。

Abstract:

Objective To investigate the safety and efficacy of LVIS stent-assisted embolization in treating ruptured intracranial aneurysms. Methods A retrospective analysis was performed on the clinical data, embolization rate, and complications of 118 cases of ruptured intracranial aneurysm who were admitted to the Department of Cerebrovascular Intervention of Zhongshan People's Hospital from January 2016 to June 2019 and treated with LVIS stent-assisted embolization. Results All 118 ruptured intracranial aneurysms were successfully embolized. The embolization results immediately after operation were as follows:Raymond grade I embolization was achieved in 82 cases (69.5%), grade II embolization in 29 cases (24.6%), and grade III embolization in 7 cases (5.9%). The LVIS stent was fully open in 116 cases (98.3%) during the operation, and not fully open in 2 cases (1.7%). Six patients (5.1%) had cerebral thrombosis during the operation, of which 3 were timely treated with tirofiban and then the thrombosis disappeared, while the other 3 still had symptoms of cerebral thrombosis and cerebral infarction after medication. Postoperative thrombotic events occurred in 2 cases (1.7%), of which 1 case still had symptoms of neurological defects after active treatment. During the postoperative follow-up period of 6-12 months, aneurysm recurred in 6 patients (5.1%), in-stent stenosis occurred in 5 patients (4.2%), and no rebleeding occurred in any patient; 102 patients (86.4%) had good outcome (modified Rankin Scale:0-2) and 16 (13.6%) had poor outcome. Conclusions LVIS stent-assisted embolization is safe and feasible in treating ruptured intracranial aneurysms.