Y形支架辅助栓塞颅内动脉分叉部宽颈动脉瘤临床效果分析
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摘要
目的探讨Y形支架辅助栓塞治疗颅内动脉分叉部宽颈动脉瘤的可行性、安全性及有效性。方法回顾性分析2013年4月至2017年8月采用Y形支架辅助栓塞治疗的28例分叉部宽颈动脉瘤患者临床资料。根据Raymond分级评估术后即刻动脉瘤栓塞效果,出院时评估改良Rankin量表(mRS)评分。影像学和临床随访4～24个月,平均9.5个月。结果 28例患者28枚宽颈动脉瘤,其中破裂动脉瘤15枚(Hunt-Hess 1级5例,2级8例,3级1例,4级1例)。Y型支架辅助弹簧圈栓塞技术成功27例,失败1例。术后即刻Raymond分级Ⅰ级13例(48.2%),Ⅱ级8例(29.6%),Ⅲ级6例(22.2%);4例(14.8%)发生手术相关并发症,其中2例经治疗后完全恢复,1例遗留神经功能缺失,1例非手术区域血肿;出院时mRS评分0～1分24例,4分3例。平均随访9.5个月,影像学复查17例(63%)(DSA 15例,MRA 1例,CTA 1例);Raymond分级Ⅰ级11例(64.7%),Ⅱ级6例(35.3%),栓塞好转率为41.2%,1例瘤颈口复发;mRS评分0～1分24例,3分1例,4分2例。结论 Y形支架辅助弹簧圈栓塞治疗颅内动脉分叉部宽颈动脉瘤安全有效,近期疗效满意,远期疗效有待进一步随访观察。
Objective To evaluate the feasibility, safety and efficacy of Y-shaped stent-assisted embolization in treating wide-necked aneurysms located at bifurcation of intracranial artery. Methods The clinical data of 28 patents with wide-necked aneurysms located at bifurcation of intracranial artery, who received Y-shaped stent-assisted embolization therapy during the period from April 2013 to August 2017,were retrospectively analyzed. Raymond grading criterion was used to evaluate the immediate embolization effect of aneurysms after treatment, and at the time of discharge from hospital the curative effect was assessed by using modified Rankin scale(mRS). Imaging and clinical follow-up was conducted for 4-24 months, with a mean of 9.5 months. Results A total of 28 aneurysms were detected in 28 patents. Among the 28 aneurysms, 15 aneurysms were ruptured, which, according to Hunt-Hess classification, included grade I(n=5), grade Ⅱ(n=8), grade Ⅲ(n=1) and grade Ⅳ(n=1). The Y-shaped stent-assisted embolization was successfully accomplished in 27 patients, and failed in one patient. Immediate postoperative Raymond classification showed that grade I was seen in 13 patients(48.2%), grade Ⅱ in 8 patients(29.6%), and grade Ⅲ in 6 patients(22.2%). Procedure-related complications occurred in 4 patients(14.8%), complete recovery after medication was obtained in two of them, residual neurologic dysfunction was seen in one patient, and hematoma at non-operative area was seen in one patient. At the time of discharge, mRS score of0-1 point was obtained in 24 patients, and 4 points in 3 patients. The patients were followed up for a mean of9.5 months. Imaging re-examination was employed in 17 patients(63%), including DSA(n=15), MRA(n=1) and CTA(n=1). Raymond classification revealed that grade I was seen in 11 patients(64.7%) and gradeⅡ in 6 patients(35.3%). The improvement rate was 41.2%, recurrence of aneurysm neck occurred in one patient. The mRS score of 0-1 point was obtained in 24 patients, 3 points in one patient, and 4 points in 2 patients. Conclusion For the treatment of wide-necked aneurysms located at bifurcation of intracranial artery, Y-shaped stent-assisted embolization therapy is safe and effective with satisfactory short-term curative effect, although the long-term effect needs to be further followed up.
Objective To evaluate the feasibility, safety and efficacy of Y-shaped stent-assisted embolization in treating wide-necked aneurysms located at bifurcation of intracranial artery. Methods The clinical data of 28 patents with wide-necked aneurysms located at bifurcation of intracranial artery, who received Y-shaped stent-assisted embolization therapy during the period from April 2013 to August 2017,were retrospectively analyzed. Raymond grading criterion was used to evaluate the immediate embolization effect of aneurysms after treatment, and at the time of discharge from hospital the curative effect was assessed by using modified Rankin scale(mRS). Imaging and clinical follow-up was conducted for 4-24 months, with a mean of 9.5 months. Results A total of 28 aneurysms were detected in 28 patents. Among the 28 aneurysms, 15 aneurysms were ruptured, which, according to Hunt-Hess classification, included grade I(n=5), grade Ⅱ(n=8), grade Ⅲ(n=1) and grade Ⅳ(n=1). The Y-shaped stent-assisted embolization was successfully accomplished in 27 patients, and failed in one patient. Immediate postoperative Raymond classification showed that grade I was seen in 13 patients(48.2%), grade Ⅱ in 8 patients(29.6%), and grade Ⅲ in 6 patients(22.2%). Procedure-related complications occurred in 4 patients(14.8%), complete recovery after medication was obtained in two of them, residual neurologic dysfunction was seen in one patient, and hematoma at non-operative area was seen in one patient. At the time of discharge, mRS score of0-1 point was obtained in 24 patients, and 4 points in 3 patients. The patients were followed up for a mean of9.5 months. Imaging re-examination was employed in 17 patients(63%), including DSA(n=15), MRA(n=1) and CTA(n=1). Raymond classification revealed that grade I was seen in 11 patients(64.7%) and gradeⅡ in 6 patients(35.3%). The improvement rate was 41.2%, recurrence of aneurysm neck occurred in one patient. The mRS score of 0-1 point was obtained in 24 patients, 3 points in one patient, and 4 points in 2 patients. Conclusion For the treatment of wide-necked aneurysms located at bifurcation of intracranial artery, Y-shaped stent-assisted embolization therapy is safe and effective with satisfactory short-term curative effect, although the long-term effect needs to be further followed up.
引文
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[13]Limbucci N,Renieri L,Nappini S,et al.Y-stent assisted coiling of bifurcation aneurysms with enterprise stent:long-term follow-up[J].J Neurointerv Surg,2016,8:158-162.
[14]Martinez-Galdamez M,Saura P,Saura J,et al.Y-stent-assisted coil embolization of anterior circulation aneurysms using two solitaire AB devices:a single center experience[J].Intervent Neuroradiol,2012,18:158-163.
[15]Zhao KJ,Yang PF,Huang QH,et al.Y-configuration stent placement(crossing and kissing)for endovascular treatment of wide-neck cerebral aneurysms located at 4 different bifurcation sites[J].AJNR Am J Neuroradiol,2012,33:1310-1316.
[16]Henkes H,Kirsch M,Mariushi W,et al.Coil treatment of a fusiform upper basilar trunk aneurysm with a combination of“kissing”neuroform stents,Tri Span-,3D-and fibered coils,and permanent implantation of the microguidewires[J].Neuroradiology,2004,46:464-468.
[17]Jankowitz BT,Thomas A,Jovin T,et al.Y stenting using kissing stents for the treatment of bifurcation aneurysms[J].J Neurointerv Surg,2012,4:16-21.
[18]Bartolini B,Blanc R,Pistocchi S,et al.“Y”and“X”stentassisted coiling of complex and wide-neck intracranial bifurcation aneurysms[J].AJNR Am J Neuroradiol,2014,35:2153-2158.
[19]Saatci I,Geyik S,Yavuz K,et al.X-configured stent-assisted coiling in the endovascular treatment of complex anterior communicating artery aneurysms:a novel reconstructive technique[J].AJNR Am J Neuroradiol,2011,32:E113-E117.
[20]Yavuz K,Geyik S,Cekirge S,et al.Double stent-assisted coil embolization treatment for bifurcation aneurysms:immediate treatment results and long-term angiographic outcome[J].AJNR Am J Neuroradiol,2013,34:1778-1784.
[21]Shapiro M,Becske T,Sahlein D,et al.Stent-supported aneurysm coiling:a literature survey of treatment and follow-up[J].AJNR Am J Neuroradiol,2012,33:159-163.
[22]Lubicz B,Morais R,Bruyere PJ,et al.Stent-assisted coiling of wide-neck bifurcation aneurysms with a branch incorporated in the aneurysm base:long-term follow-up in 49 patients with 53aneurysms[J].Neuroradiology,2017,59:619-624.
[23]Fargen KM,Mocco J,Neal D,et al.A multicenter study of stent-assisted coiling of cerebral aneurysms with a Y configuration[J].Neurosurgery,2013,73:466-472.
[24]Zhang JZ,Yang PF,Huang QH,et al.Stent-assisted coiling strategies for the treatment of wide-necked basilar artery bifurcation aneurysms[J].J Clin Neurosci,2014,21:962-967.
[25]Lubicz B.Linear stent-assisted coiling:another way to treat very wide-necked intracranial aneurysms[J].Neuroradiology,2011,53:457-459.
[26]Rahal JP,Dandamudi VS,Safain MG,et al.Double waffle-cone technique using twin solitaire detachable stents for treatment of an ultra-wide necked aneurysm[J].J Clin Neurosci,2014,21:1019-1023.
[27]Limbucci N,Nappini S,Renieri L,et al.Hybrid y stenting with the waffle-cone.A technical note[J].Interv Neuroradiol,2014,20:677-685.
[28]郭新宾,陈振,王子博,等.Waffle cone技术栓塞颅内动脉瘤初步经验探讨[J].中华医学杂志,2014,94:1346-1348.
[29]Aydin K,Sencer S,Barburoglu MA,et al.Midterm results of Tstent-assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents[J].J Neurosurg,2017,127:1288-1296.
[30]Gory B,Spiotta AM,Di Paola F,et al.Pulse Rider for treatment of wide-neck bifurcation intracranial aneurysms:6-month results[J].World Neurosurg,2017,99:605-609.
[31]Pierot L,Moret J,Barreau X,et al.Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective,multicenter series[J].J Neurointerv Surg,2018,10:553-559.
[32]Popielski J,Berlis A,Weber W,et al.Two-center experience in the endovascular treatment of ruptured and unruptured intracranial aneurysms using the WEB device:a retrospective analysis[J].AJNR Am J Neuroradiol,2018,39:111-117.
[2]Chow MM,Woo HH,Masaryk TJ,et al.A novel endovascular treatment of a wide-necked basilar apex aneurysm by using a Yconfiguration,double-stent technique[J].AJNR Am J Neuroradiol,2004,25:509-512.
[3]巴华君,蔡建勇,陆川,等.支架辅助下弹簧圈栓塞颅内宽颈动脉瘤长期随访分析[J].介入放射学杂志,2015,24:5-9.
[4]Mühl-Benninghaus R,Simgen A,Reith W,et al.The barrel stent:new treatment option for stent-assisted coiling of widenecked bifurcation aneurysms:results of a single-center study[J].J Neurointerv Surg,2017,9:1219-1222.
[5]Brinjikji W,Kallmes DF,Kadirvel R.Mechanisms of healing in coiled intracranial aneurysms:a review of the literature[J].AJNR Am J Neuroradiol,2015,36:1216-1222.
[6]Kono K,Terada T.Hemodynamics of 8 different configurations of stenting for bifurcation aneurysms[J].AJNR Am J Neuroradiol,2013,34:1980-1986.
[7]Babiker MH,Gonzalez LF,Ryan J,et al.Influence of stent configuration on cerebral aneurysm fluid dynamics[J].J Biomech,2012,45:440-447.
[8]Melber K,Meila D,Draheim P,et al.Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms[J].J Neurointerv Surg,2017,9:1233-1237.
[9]Cekirge HS,Yavuz K,Geyik S,et al.A novel“Y”stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling[J].AJNR Am J Neuroradiol,2011,32:1262-1268.
[10]徐浩文,李明华,管生,等.“Y”型支架技术辅助弹簧圈栓塞基底动脉尖部宽颈动脉瘤[J].介入放射学杂志,2011,20:352-356.
[11]Akgul E,Balli T,Aksungur EH.Hybrid,Y-configured,dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms[J].Interv Neuroradiol,2015,21:29-39.
[12]Lee K,Park H,Park I,et al.Y-configuration stent-assisted coil embolization for wide-necked intracranial bifurcation aneurysms[J].J Cerebrovasc Endovasc Neurosurg,2016,18:355-362.
[13]Limbucci N,Renieri L,Nappini S,et al.Y-stent assisted coiling of bifurcation aneurysms with enterprise stent:long-term follow-up[J].J Neurointerv Surg,2016,8:158-162.
[14]Martinez-Galdamez M,Saura P,Saura J,et al.Y-stent-assisted coil embolization of anterior circulation aneurysms using two solitaire AB devices:a single center experience[J].Intervent Neuroradiol,2012,18:158-163.
[15]Zhao KJ,Yang PF,Huang QH,et al.Y-configuration stent placement(crossing and kissing)for endovascular treatment of wide-neck cerebral aneurysms located at 4 different bifurcation sites[J].AJNR Am J Neuroradiol,2012,33:1310-1316.
[16]Henkes H,Kirsch M,Mariushi W,et al.Coil treatment of a fusiform upper basilar trunk aneurysm with a combination of“kissing”neuroform stents,Tri Span-,3D-and fibered coils,and permanent implantation of the microguidewires[J].Neuroradiology,2004,46:464-468.
[17]Jankowitz BT,Thomas A,Jovin T,et al.Y stenting using kissing stents for the treatment of bifurcation aneurysms[J].J Neurointerv Surg,2012,4:16-21.
[18]Bartolini B,Blanc R,Pistocchi S,et al.“Y”and“X”stentassisted coiling of complex and wide-neck intracranial bifurcation aneurysms[J].AJNR Am J Neuroradiol,2014,35:2153-2158.
[19]Saatci I,Geyik S,Yavuz K,et al.X-configured stent-assisted coiling in the endovascular treatment of complex anterior communicating artery aneurysms:a novel reconstructive technique[J].AJNR Am J Neuroradiol,2011,32:E113-E117.
[20]Yavuz K,Geyik S,Cekirge S,et al.Double stent-assisted coil embolization treatment for bifurcation aneurysms:immediate treatment results and long-term angiographic outcome[J].AJNR Am J Neuroradiol,2013,34:1778-1784.
[21]Shapiro M,Becske T,Sahlein D,et al.Stent-supported aneurysm coiling:a literature survey of treatment and follow-up[J].AJNR Am J Neuroradiol,2012,33:159-163.
[22]Lubicz B,Morais R,Bruyere PJ,et al.Stent-assisted coiling of wide-neck bifurcation aneurysms with a branch incorporated in the aneurysm base:long-term follow-up in 49 patients with 53aneurysms[J].Neuroradiology,2017,59:619-624.
[23]Fargen KM,Mocco J,Neal D,et al.A multicenter study of stent-assisted coiling of cerebral aneurysms with a Y configuration[J].Neurosurgery,2013,73:466-472.
[24]Zhang JZ,Yang PF,Huang QH,et al.Stent-assisted coiling strategies for the treatment of wide-necked basilar artery bifurcation aneurysms[J].J Clin Neurosci,2014,21:962-967.
[25]Lubicz B.Linear stent-assisted coiling:another way to treat very wide-necked intracranial aneurysms[J].Neuroradiology,2011,53:457-459.
[26]Rahal JP,Dandamudi VS,Safain MG,et al.Double waffle-cone technique using twin solitaire detachable stents for treatment of an ultra-wide necked aneurysm[J].J Clin Neurosci,2014,21:1019-1023.
[27]Limbucci N,Nappini S,Renieri L,et al.Hybrid y stenting with the waffle-cone.A technical note[J].Interv Neuroradiol,2014,20:677-685.
[28]郭新宾,陈振,王子博,等.Waffle cone技术栓塞颅内动脉瘤初步经验探讨[J].中华医学杂志,2014,94:1346-1348.
[29]Aydin K,Sencer S,Barburoglu MA,et al.Midterm results of Tstent-assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents[J].J Neurosurg,2017,127:1288-1296.
[30]Gory B,Spiotta AM,Di Paola F,et al.Pulse Rider for treatment of wide-neck bifurcation intracranial aneurysms:6-month results[J].World Neurosurg,2017,99:605-609.
[31]Pierot L,Moret J,Barreau X,et al.Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective,multicenter series[J].J Neurointerv Surg,2018,10:553-559.
[32]Popielski J,Berlis A,Weber W,et al.Two-center experience in the endovascular treatment of ruptured and unruptured intracranial aneurysms using the WEB device:a retrospective analysis[J].AJNR Am J Neuroradiol,2018,39:111-117.