CAJ | 학술논문

目的评估电解脱Solitaire支架辅助栓塞颅内宽颈及夹层动脉瘤的有效性和安全性.方法回顾分析2010年8月至2012年1月利用Solitaire支架辅助栓塞38例患者40个颅内宽颈和夹层动脉瘤的治疗和预后.其中男性12例,女性26例；年龄21～ 78岁,平均55岁.患者均行全脑血管造影检查,证实为宽颈动脉瘤31例,夹层动脉瘤9例.颅内动脉瘤破裂致蛛网膜下腔出血29例,其中自发性蛛网膜下腔出血28例,入院Hunt-Hess分级,Ⅰ级1例,Ⅱ级20例,Ⅲ级4例,Ⅳ级3例；外伤性颅内动脉瘤1例.垂体瘤术中动脉瘤出血1例,未破裂颅内动脉瘤8例.动脉瘤位于颈内动脉后交通段21个,颈内动脉床突上段6个,颈内动脉海绵窦段3个,前交通复合体1个,椎动脉9个.患者术后6个月进行DSA检查及GOS评分评价预后.结果共应用Solitaire支架40个,均成功释放,但术中急性血栓形成3个,均予支架回收.Raymond栓塞分级,完全栓塞31个(77.5％),瘤颈残留5个(12.5％),部分栓塞4个(10.0％).随访时间3 ～ 12个月,中位时间6个月.末次随访DSA检查患者均未出现动脉瘤复发,行GOS预后评分,患者预后良好34例,轻残3例,死亡1例.结论应用Solitaire支架辅助栓塞宽颈和夹层动脉瘤是安全的,而且当术中急性血栓形成后可有效地将支架及血栓回收取出,恢复载瘤动脉的通畅性,降低手术并发症.
목적 평고전해탈Solitaire지가보조전새로내관경급협층동맥류적유효성화안전성.방법 회고분석2010년8월지2012년1월이용Solitaire지가보조전새38례환자40개로내관경화협층동맥류적치료화예후.기중남성12례,녀성26례；년령21～ 78세,평균55세.환자균행전뇌혈관조영검사,증실위관경동맥류31례,협층동맥류9례.로내동맥류파렬치주망막하강출혈29례,기중자발성주망막하강출혈28례,입원Hunt-Hess분급,Ⅰ급1례,Ⅱ급20례,Ⅲ급4례,Ⅳ급3례；외상성로내동맥류1례.수체류술중동맥류출혈1례,미파렬로내동맥류8례.동맥류위우경내동맥후교통단21개,경내동맥상돌상단6개,경내동맥해면두단3개,전교통복합체1개,추동맥9개.환자술후6개월진행DSA검사급GOS평분평개예후.결과 공응용Solitaire지가40개,균성공석방,단술중급성혈전형성3개,균여지가회수.Raymond전새분급,완전전새31개(77.5％),류경잔류5개(12.5％),부분전새4개(10.0％).수방시간3 ～ 12개월,중위시간6개월.말차수방DSA검사환자균미출현동맥류복발,행GOS예후평분,환자예후량호34례,경잔3례,사망1례.결론 응용Solitaire지가보조전새관경화협층동맥류시안전적,이차당술중급성혈전형성후가유효지장지가급혈전회수취출,회복재류동맥적통창성,강저수술병발증.
Objective To evaluate the efficacy and safety of SolitaireTM AB neurovascular stentingassisted coil embolization for patients with wide-necked or dissecting aneurysms.Methods The clinical results and prognosis from a consecutive series of 38 patients with 40 wide-necked or dissecting aneurysms aneurysms who treated by SolitaireTM AB neurovascular stenting-assisted coil embolization from August 2010 to January 2012 was retrospectively analyzed.There were 12 male and 26 female patients,the age was 21-78 years (mean 55 years).Thirty-one cases were confirmed wide-neck aneurysms and 9 cases were dissection aneurysms by DSA.Acute subarachnoed hemorrhage due to the rupture of aneurysms was seen in 28 cases(according Hunt-Hess scale,1 case of Class Ⅰ,20 cases of Class Ⅱ,4 cases of ClassⅢ,3 cases of Class Ⅳ),1 case was traumatic intracranial aneurysm,1 case was misdiagnosed during the operation of pituitary adenoma by the approach of transsphenoid,and unruptured aneurysms were seen in 8 cases.The aneurysms were located at the posterior communicating segment of internal carotid artery (21 cases),the supraclinoid segment of internal carotid artery (6 cases),the cavernous segment of internal carotid artery (3 cases),the anterior communicating artery (1 case),and the vertebral artery(9 cases).The patients were performed DSA and Glasgow outcome score (GOS) to evaluate the prognosis 6 months after surgery.Results Forty stents were used and all remodeling device were achieved successful position.Owing to acute thrombosis in 3 patients,the stents were retrieved successfully.The proportion of patients in whom Raymond class 1 occlusion was obtained in 31 cases(77.5％),Raymond class 2 occlusion in 5 cases (12.5％)and Raymond class 3 occlusion in 4 cases (10.0％).The follow-up was 3 to 12 months(median 6 months).The results of DSA indicated none of the patients'anuerysm was recurred; and GOS was applied to evaluate the prognosis of patients after 3 months.Of 38 patients,34 recovered well,3 moderately disabled,1 patient died.Conclusions It is safe to embolize aneurysms with SolitaireTM AB neurovascular stenting-assisted coil; meanwhile,the stents can be retrieved when acute thrombosis to reduce the complications.