中国卒中杂志
中國卒中雜誌
중국졸중잡지
CHINESE JOURNAL OF STROKE
2013年
11期
862-867
,共6页
张照龙%杨鹏飞%封灏%李强%方亦斌%杨志刚%黄清海%许奕%洪波%赵文元%刘建民
張照龍%楊鵬飛%封灝%李彊%方亦斌%楊誌剛%黃清海%許奕%洪波%趙文元%劉建民
장조룡%양붕비%봉호%리강%방역빈%양지강%황청해%허혁%홍파%조문원%류건민
动脉瘤%复发%支架%治疗%预后
動脈瘤%複髮%支架%治療%預後
동맥류%복발%지가%치료%예후
Aneurysm%Recurrence%Stent%Treatment%Prognosis
目的评价支架治疗介入栓塞后复发颅内动脉瘤的可行性、安全性和有效性。<br> 方法回顾性分析第二军医大学附属长海医院神经外科2006年6月~2013年3月应用支架治疗的介入栓塞术后复发颅内动脉瘤病例,共83例患者、83枚复发动脉瘤。对患者的临床、影像学资料、治疗方案、治疗结果、并发症及预后等进行分析。<br> 结果所有83例患者共应用93枚支架,支架植入顺利,技术成功率100%。动脉瘤即刻治疗结果,33例单纯支架植入术的病例中,18例(54.5%)术后即刻动脉瘤内造影剂滞留,15例(45.5%)单纯支架植入术后即刻数字减影血管造影(digital substraction angiography,DSA)同术前相比无明显改变。支架结合弹簧圈治疗的50例患者中,按Raymond分级,Ⅰ级11例(22.0%),Ⅱ级21例(42.0%),Ⅲ级18例(36.0%),载瘤动脉均保持通畅。共发生与支架植入术相关并发症2例(2.4%),均为脑血管痉挛,给予动脉灌注罂粟碱后好转,出院时无神经功能损害。出院时改良Rankin量表(modified Rankin Scale, mRS)评分:0~2分82例(98.8%),3分1例(1.2%)。影像学随访50例(60.2%)患者,随访时间2~52个月,中位随访时间11个月。单纯支架植入随访20例结果显示:致密栓塞14例(70.0%),动脉瘤内进一步血栓形成3例(15.0%),动脉瘤稳定3例(15.0%)。支架辅助弹簧圈栓塞30例随访结果为:致密栓塞20例(66.7%),进一步血栓形成3例(10.0%),稳定3例(10.0%),小复发2例(6.7%),大复发1例(3.3%),再次破裂出血1例(3.3%)。所有患者均获临床随访,随访时间2~82个月,中位随访时间30个月,除发生再出血的患者接受再次治疗并痊愈外,均无新发神经功能缺损。<br> 结论颅内支架治疗颅内复发动脉瘤技术上可行,安全性高,结果满意,但长期疗效仍有待进一步随访。
目的評價支架治療介入栓塞後複髮顱內動脈瘤的可行性、安全性和有效性。<br> 方法迴顧性分析第二軍醫大學附屬長海醫院神經外科2006年6月~2013年3月應用支架治療的介入栓塞術後複髮顱內動脈瘤病例,共83例患者、83枚複髮動脈瘤。對患者的臨床、影像學資料、治療方案、治療結果、併髮癥及預後等進行分析。<br> 結果所有83例患者共應用93枚支架,支架植入順利,技術成功率100%。動脈瘤即刻治療結果,33例單純支架植入術的病例中,18例(54.5%)術後即刻動脈瘤內造影劑滯留,15例(45.5%)單純支架植入術後即刻數字減影血管造影(digital substraction angiography,DSA)同術前相比無明顯改變。支架結閤彈簧圈治療的50例患者中,按Raymond分級,Ⅰ級11例(22.0%),Ⅱ級21例(42.0%),Ⅲ級18例(36.0%),載瘤動脈均保持通暢。共髮生與支架植入術相關併髮癥2例(2.4%),均為腦血管痙攣,給予動脈灌註罌粟堿後好轉,齣院時無神經功能損害。齣院時改良Rankin量錶(modified Rankin Scale, mRS)評分:0~2分82例(98.8%),3分1例(1.2%)。影像學隨訪50例(60.2%)患者,隨訪時間2~52箇月,中位隨訪時間11箇月。單純支架植入隨訪20例結果顯示:緻密栓塞14例(70.0%),動脈瘤內進一步血栓形成3例(15.0%),動脈瘤穩定3例(15.0%)。支架輔助彈簧圈栓塞30例隨訪結果為:緻密栓塞20例(66.7%),進一步血栓形成3例(10.0%),穩定3例(10.0%),小複髮2例(6.7%),大複髮1例(3.3%),再次破裂齣血1例(3.3%)。所有患者均穫臨床隨訪,隨訪時間2~82箇月,中位隨訪時間30箇月,除髮生再齣血的患者接受再次治療併痊愈外,均無新髮神經功能缺損。<br> 結論顱內支架治療顱內複髮動脈瘤技術上可行,安全性高,結果滿意,但長期療效仍有待進一步隨訪。
목적평개지가치료개입전새후복발로내동맥류적가행성、안전성화유효성。<br> 방법회고성분석제이군의대학부속장해의원신경외과2006년6월~2013년3월응용지가치료적개입전새술후복발로내동맥류병례,공83례환자、83매복발동맥류。대환자적림상、영상학자료、치료방안、치료결과、병발증급예후등진행분석。<br> 결과소유83례환자공응용93매지가,지가식입순리,기술성공솔100%。동맥류즉각치료결과,33례단순지가식입술적병례중,18례(54.5%)술후즉각동맥류내조영제체류,15례(45.5%)단순지가식입술후즉각수자감영혈관조영(digital substraction angiography,DSA)동술전상비무명현개변。지가결합탄황권치료적50례환자중,안Raymond분급,Ⅰ급11례(22.0%),Ⅱ급21례(42.0%),Ⅲ급18례(36.0%),재류동맥균보지통창。공발생여지가식입술상관병발증2례(2.4%),균위뇌혈관경련,급여동맥관주앵속감후호전,출원시무신경공능손해。출원시개량Rankin량표(modified Rankin Scale, mRS)평분:0~2분82례(98.8%),3분1례(1.2%)。영상학수방50례(60.2%)환자,수방시간2~52개월,중위수방시간11개월。단순지가식입수방20례결과현시:치밀전새14례(70.0%),동맥류내진일보혈전형성3례(15.0%),동맥류은정3례(15.0%)。지가보조탄황권전새30례수방결과위:치밀전새20례(66.7%),진일보혈전형성3례(10.0%),은정3례(10.0%),소복발2례(6.7%),대복발1례(3.3%),재차파렬출혈1례(3.3%)。소유환자균획림상수방,수방시간2~82개월,중위수방시간30개월,제발생재출혈적환자접수재차치료병전유외,균무신발신경공능결손。<br> 결론로내지가치료로내복발동맥류기술상가행,안전성고,결과만의,단장기료효잉유대진일보수방。
Objective To evaluate the feasibility, effectiveness, and safety of recurrent aneurysm treatment with stent. <br> Methods A retrospective review was conducted for 83 patients with recurrent intracranial aneurysms who underwent endovascular treatment with stent in Department of Neurosurgery, Changhai Hospital, between June 2006 and March 2013. <br> Results For these 83 patients with recurrent aneurysms, 93 stents were deployed successfully, and 10 patients received dual stent placement. Among them, 33 patients were treated with stent placement alone and 50 patients received stent-assisted coil embolization. In the patients treated with stent placement alone, residual iflling of contrast medium in the aneurysms was seen in 18 patients (54.5%) immediately after the stent placement. However, no obvious difference was seen in 15 patients (45.5%). Of the 50 aneurysms treated with stent-assisted embolization, complete occlusion was achieved in 11 aneurysms (22.0%);residual neck remained in 21 aneurysms (42.0%), and residual aneurysm was present in 18 aneurysms (36.0%). Procedure-related complication occurred in 2 patients. They both suffered vasospasm and was discharged with no deifcit. The modiifed Rankin Scale (mRS) score at discharge was 0~2 in 82 patients (98.8%) and 3 in one patient (1.2%). Follow-up angiographies were available in 50 (60.2%) patients (ranging 2~52 months, median 11 months). The results of 20 patients treated by stent placement alone showed complete occlusion in 14 (70.0%), progressive occlusion in 3 (15.0%) and stable in 3 (15.0%). Follow-up of 30 patients treated by stent assisted coil embolization showed complete occlusion in 20 (66.7%), progressive occlusion in 3 (10.0%), stable in 3 (10.0%), minor recanalization in 2 (6.7%), major recanalization in 1 (3.3%) and rerupture in 1 (3.3%). The clinical follow-up (ranging 2~82 months, median 30 months) demonstrated no neurologic deterioration except the one suffering SAH, who received endovascular treatment again without neurologic deifcit. <br> Conclusion The treatment of recurrent intracranial aneurysms with stents can be successfully achieved with satisfactory midterm results.