CAJ | 학술논문

目的探讨载瘤动脉内单个支架置入治疗前循环未破裂宽颈微小动脉瘤的短期疗效.方法 2008年1月至2013年7月北京医院神经外科采用载瘤动脉单个支架置入治疗11个前循环未破裂宽颈微小囊状动脉瘤,动脉瘤最大径为2.0 ～3.0 mm,平均(2.4 ±0.4)mm;宽/颈比均≤1.2;颈内动脉床突段2个、后交通动脉起始部4个、脉络膜前动脉起始部2个、大脑中动脉水平段分叉部3个;所有颈内动脉动脉瘤均位于颈内动脉内侧和(或)腹侧壁.随访时通过血管造影复查与门诊或电话随访,统计动脉瘤闭塞与破裂出血情况.结果 9个动脉瘤按计划直接行载瘤动脉单纯支架置入,另2个在载瘤动脉支架置入后试行弹簧圈栓塞但微导管插管未成功.共成功置入10枚支架,其中1枚支架同时治疗2个串联的动脉瘤.仅1个动脉瘤术后即刻造影显示变小.无围手术期并发症发生.所有动脉瘤随访时间8～24个月,平均(13±6)个月,8个动脉瘤大小无改变,2个变小,仅1个动脉瘤完全闭塞;变小或闭塞的3个动脉瘤均存在载瘤动脉的无症状性支架内再狭窄.临床随访无动脉瘤破裂出血.结论对于前循环有分支动脉发出部位的未破裂、宽颈微小动脉瘤,载瘤动脉内单个支架置入虽然安全,可作为治疗选择之一,但短期随访闭塞率低.
목적 탐토재류동맥내단개지가치입치료전순배미파렬관경미소동맥류적단기료효.방법 2008년1월지2013년7월북경의원신경외과채용재류동맥단개지가치입치료11개전순배미파렬관경미소낭상동맥류,동맥류최대경위2.0 ～3.0 mm,평균(2.4 ±0.4)mm;관/경비균≤1.2;경내동맥상돌단2개、후교통동맥기시부4개、맥락막전동맥기시부2개、대뇌중동맥수평단분차부3개;소유경내동맥동맥류균위우경내동맥내측화(혹)복측벽.수방시통과혈관조영복사여문진혹전화수방,통계동맥류폐새여파렬출혈정황.결과 9개동맥류안계화직접행재류동맥단순지가치입,령2개재재류동맥지가치입후시행탄황권전새단미도관삽관미성공.공성공치입10매지가,기중1매지가동시치료2개천련적동맥류.부1개동맥류술후즉각조영현시변소.무위수술기병발증발생.소유동맥류수방시간8～24개월,평균(13±6)개월,8개동맥류대소무개변,2개변소,부1개동맥류완전폐새;변소혹폐새적3개동맥류균존재재류동맥적무증상성지가내재협착.림상수방무동맥류파렬출혈.결론 대우전순배유분지동맥발출부위적미파렬、관경미소동맥류,재류동맥내단개지가치입수연안전,가작위치료선택지일,단단기수방폐새솔저.
Objective To evaluate the short-term outcome of single stenting technique for unruptured,wide-necked,tiny aneurysms of the anterior circulation.Methods Eleven unruptured,widenecked,tiny aneurysms of the anterior circulation were treated by a single stent deployed in the parent artery between January 2008 and July 2013 in Department of Neurosurgery in Beijing Hospital.The maximum diameter of the aneurysms ranged from 2.0 to 3.0 mm,mean (2.4 ± 0.4) mm,and the dome-to-neck ratios were all ≤ 1.2.The locations were clinoid segment of internal carotid artery (n =2),posterior communicating artery origin (n =4),anterior choroidal artery origin (n =2) and middle cerebral artery bifurcation (n =3).All internal carotid aneurysms were located in the medial and/or ventral wall of the internal carotid artery.The rate of aneurysm obliteration and rupture during follow-up was obtained by repeat angiography and clinic or telephone interview respectively.Results Sole stent placement in the parent artery was intentionally performed for nine aneurysms,while attempt of coiling after stent deployment for the other two aneurysms failed due to unsuccessful microcatherization.Ten stents were successfully deployed,of which one was used to treat two tandem lesions simultaneously.Only one aneurysm became smaller immediately postprocedure.No perioperative complications occurred.Angiographic follow-up after a mean period of (13 ± 6)months (range 8-24 months) revealed that 8 aneurysms did no change in size,2 became smaller and only one was totally occluded.Asymptomatic in-stent stenosis of the parent artery was found in all 3 shrinking or occluded aneurysms.No aneurysm rupture was observed in the clinical follow-up.Conclusion For those unruptured,wide-necked,tiny aneurysms arising at branching sites in the anterior circulation,single stenting technique seems to be a safe alternative treatment,while the short-term rate of aneurysm occlusion is low.