CAJ | 학술논문

目的观察Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤初中期效果。方法回顾性分析2009年至2012年期间采用Solitaire AB支架辅助弹簧圈栓塞治疗的49例颅内宽颈动脉瘤患者49个动脉瘤，其中41例患者41个动脉瘤（26个破裂出血，15个未破裂）术后随访12～48个月，根据改良Rankin评分、DSA、CTA或MRA检查评价颅内动脉瘤影像学及临床结果。结果栓塞术后有2例动脉瘤再次破裂出血，3例脑梗死，1例载瘤动脉闭塞，死亡1例，并发症发生率为14.2%。栓塞术后12个月DSA、MRA或CTA检查显示，32个动脉瘤（32/41，78.0%）完全栓塞，明显高于术后即刻（21个，42.9%）（P＝0.02）；瘤颈残留7个（17.1%），部分栓塞2个（4.9%），均较术后即刻有改善。24个动脉瘤（58.5%）稳定而无变化，复发4个（9.7%）。末次随访时改良Rankin评分显示0分18例（43.9%），1分10例（24.4%），2分5例（12.2%），3分4例（9.8%），4分2例（4.85%），5分2例（4.85%）。患者日常活动能力自理率为80.5%，预后良好。结论 Solitaire AB支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤安全有效，有助于提高完全栓塞率，降低操作相关并发症。
목적관찰Solitaire AB지가보조탄황권전새치료로내관경동맥류초중기효과。방법회고성분석2009년지2012년기간채용Solitaire AB지가보조탄황권전새치료적49례로내관경동맥류환자49개동맥류，기중41례환자41개동맥류（26개파렬출혈，15개미파렬）술후수방12～48개월，근거개량Rankin평분、DSA、CTA혹MRA검사평개로내동맥류영상학급림상결과。결과전새술후유2례동맥류재차파렬출혈，3례뇌경사，1례재류동맥폐새，사망1례，병발증발생솔위14.2%。전새술후12개월DSA、MRA혹CTA검사현시，32개동맥류（32/41，78.0%）완전전새，명현고우술후즉각（21개，42.9%）（P＝0.02）；류경잔류7개（17.1%），부분전새2개（4.9%），균교술후즉각유개선。24개동맥류（58.5%）은정이무변화，복발4개（9.7%）。말차수방시개량Rankin평분현시0분18례（43.9%），1분10례（24.4%），2분5례（12.2%），3분4례（9.8%），4분2례（4.85%），5분2례（4.85%）。환자일상활동능력자리솔위80.5%，예후량호。결론 Solitaire AB지가보조탄황권전새치료로내관경동맥류안전유효，유조우제고완전전새솔，강저조작상관병발증。
Objective To investigate the mid-term effect of SolitaireAB stent-assisted interventional embolization with spring coils for the treatment of intracranial wide-necked aneurysms. Methods During the period from May 2009 to April 2013, a total of 49 patients with intracranial wide-necked aneurysm (49 aneurysms in total) received SolitaireAB stent-assisted interventional embolization treatment at authors’ hospital. In 41 patients, a total of 41 aneurysms were detected, of which ruptured aneurysm with bleeding was confirmed in 26 and un-ruptured aneurysm in 15. These 41 patients were followed up for 12-48 months. Based on modified Rankin scoring and DSA, CTA or MRA manifestations, the clinical results were evaluated. Results After the embolization treatment, re-bleeding of the aneurysm occurred in 2 cases, cerebral infarction in 3 cases, occlusion of the parent artery in one case and death in one case; the occurrence rate of complications was 14.2%. DSA, MRA or CTA performed at 12 months after the embolization treatment, showed that 32 aneurysms (78.0%) were completely obstructed, which was obviously higher than that observed on DSA performed immediately after the embolization procedure (21 aneurysms, 42.9%), the difference was statistically significant (P=0.02);residue of aneurismal neck was seen in 7 cases (17.1%) and partial occlusion in 2 cases (4.9%), which were much better than those observed on DSA that was performed immediately after the embolization procedure. Twenty-four aneurysms (58.5%) remained stable, showing no any change, and recurrence of aneurysm was observed in 4 cases (9.7%). At the last follow-up exam, the modified Rankin scoring showed that 0 point was seen in 18 cases (43.9%), one point in 10 cases (24.4%), 2 points in 5 cases (12.2%), 3 points in 4 cases (9.8%), 4 points in 2 cases (4.85%) and 5 points in 2 cases (4.85%). The self-care rate for daily activities was 80.5%, the prognosis was good. Conclusion For the treatment of intracranial wide-necked aneurysms, SolitaireAB stent-assisted interventional embolization with spring coils is safe and effective. This technique can improve the embolization rate and reduce the procedure-related complications.