摘要
1.目的：探讨和总结目前临床常用颅内支架的特点及应用时注意事项,并将其系统化、理论化,为以后的临床工作提供理论支持。
2.方法：本文回顾我院治疗中心自2003年10月至2013年11月10年,应用的共227枚LEO支架、Neuroform支架、Enterprise支架、Solitaire AB支架的临床资料,并对相关资料汇总分析。对术中应用支架的相关技术进行讨论,按应用支架类型进行分类,对于各类型支架术中支架到位情况,释放后移位情况,有无塌陷及血栓形成情况,术后复发等情况进行统计学分析,数据用(Stata)统计软件处理。
3.结果：本组184病人中共对211个动脉瘤行栓塞治疗。应用227个颅内支架。其中LEO支架39枚,Neuroform支架51枚,Enterprise支架62枚,SolitaireAB支架75枚。经统计学分析,术中操作时Enterprise支架柔顺性最佳,其次为Solitaire AB、Neuroform支架,该两种支架无明显差异,LEO支架较上述三种支架差,其中Enterprise支架径向支撑力差,其余三种支架无统计学差异,Solitaire AB支架术中支架移位发生率最低,术中后血栓形成情况为LEO、Solitaire AB支架最高,余两种支架无明显差异。上述四种支架术中动脉瘤破裂出血及治疗的颅内动脉瘤术后半年复发率无显著差别。但单层支架结合弹簧圈栓塞血泡样动脉瘤和夹层动脉瘤复发率明显高于多层支架结合弹簧圈栓塞血泡样动脉瘤和夹层动脉瘤。
4.结论：支架在颅内动脉瘤栓塞的应用不仅适用于宽颈动脉瘤的栓塞,也同时适用于梭形动脉瘤、血泡样动脉瘤、夹层动脉瘤的治疗。支架对载瘤动脉重塑不只是针对动脉瘤囊的治疗,由于支架对载瘤动脉及动脉瘤内血流动力学变化的影响,使其对瘤颈附近病变的动脉壁亦有保护及修复作用。可明显减少动脉瘤复发率。但根据每个动脉瘤及载瘤动脉的特点选择不同支架及充分掌握每种支架的特性及操作方法是治疗成功的关键。不同的支架各有其适用对象,应做到个性化选择。对于血泡样动脉瘤和夹层动脉瘤应该用多层支架治疗。
1. Purpose:To discuss and summarize the characteristics of intracranial stents used in the clinic currently and notes of application as well as systematize and theorize them to provide theoretical support for clinical work in the future.
2. Methods:This paper reviews the clinical data of application of227intracranial stents in process of treatment from October,2003to November,2013at our hospital center, and makes an analysis and summary of the data. Meanwhile, this paper makes an analysis and summary of information related to LEO stents, Neuroform stent, Enterprise stent and Solitaire AB stent, discusses the related technologies of stents used in process of treatment and makes the classification according to the types of application stents, perform statistical analysis on these situations in process of various types of tenting, such as stent placement, displacement after deploying, collapse, thrombogenesis, postoperative recurrence and others. The data has been processed with Stata statistical software.
3.ResuIts:The211aneurysms take the embolization therapeutic for184patients in the group. The227intracranial stents are used, including LEO39stent cases, Neuroform51stent cases, Enterprise62stent cases and Solitaire AB75stent cases. The statistical analysis shows the Enterprise stent has optimum flexibility in intraoperative operating followed by Solitaire AB and Neuroform stents. There is no significant difference between Solitaire AB and Neuroform stents. LEO stent is worse than the above three stents, among which radial strength of Enterprise stent is poor and the remaining three stents have no statistically significant difference. The incidence rate of stent displacement is lowest in Solitaire AB stenting. The situations of thrombosis after surgery are respectively that the thrombosis of LEO and Solitaire AB stents is the highest and the remaining two stents have no significant difference. For above four stentings, the aneurysm rupture and recurrence rate within half a year after treatment of intracranial aneurysm have no significant difference. However, the recurrence rate of single-layer tent-assisted coil embolization pseudoaneurysm and dissecting aneurysm was significantly higher than one of the multilayer stents-assisted coil embolization pseudoaneurysm and dissecting aneurysm.
4. Conclusion:the application of endovascular stent graft to treating intracranial aneurysms is not only applicable to the wide-neck aneurysm embolization, but also fusiform aneurysms, blood blister-like aneurysm and dissecting aneurysm. The stent-assisted remodeling of the parent artery can not only treat the aneurysm sac, but also protect and repair the diseased arterial wall near the aneurysm neck because of the influence of parent artery and hemodynamic changes within the aneurysm, which can significantly reduce the recurrence rate of the aneurysm. But it is the key to successful treatment to choose different stents and fully understand the characteristics of each stent and method of operation based on the characteristics of each aneurysm and parent artery. The different stents have their own suitable objects, so it should make the personalization options. Multilayer stent should be used for blood blister-like aneurysm and dissecting aneurysm.
1.Purpose:To discuss and summarize the characteristics of intracranial stents used in the clinic currently and notes of application as well as systematize and theorize them to provide theoretical support for clinical work in the future.
2.Methods:This paper reviews the clinical data of application of227intracranial stents in process of treatment from October,2003to November,2013at our hospital center, and makes an analysis and summary of the data. Meanwhile, this paper makes an analysis and summary of information related to LEO stents, Neuroform stent, Enterprise stent and Solitaire AB stent, discusses the related technologies of stents used in process of treatment and makes the classification according to the types of application stents, perform statistical analysis on these situations in process of various types of tenting, such as stent placement, displacement after deploying, collapse, thrombogenesis, postoperative recurrence and others. The data has been processed with Stata statistical software.
3.The211aneurysms take the embolization therapeutic for184patients in the group. The227intracranial stents are used, including LEO39stent cases, Neuroform51stent cases, Enterprise62stent cases and Solitaire AB75stent cases. The statistical analysis shows the Enterprise stent has optimum flexibility in intraoperative operating followed by Solitaire AB and Neuroform stents. There is no significant difference between Solitaire AB and Neuroform stents. LEO stent is worse than the above three stents, among which radial strength of Enterprise stent is poor and the remaining three stents have no statistically significant difference. The incidence rate of stent displacement is lowest in Solitaire AB stenting. The situations of thrombosis after surgery are respectively that the thrombosis of LEO and Solitaire AB stents is the highest and the remaining two stents have no significant difference. For above four stentings, the aneurysm rupture and recurrence rate within half a year after treatment of intracranial aneurysm have no significant difference. However, the recurrence rate of single-layer tent-assisted coil embolization pseudoaneurysm and dissecting aneurysm was significantly higher than one of the multilayer stents-assisted coil embolization pseudoaneurysm and dissecting aneurysm.4.the application of endovascular stent graft to treating intracranial aneurysms is not only applicable to the wide-neck aneurysm embolization, but also fusiform aneurysms, blood blister-like aneurysm and dissecting aneurysm. The stent-assisted remodeling of the parent artery can not only treat the aneurysm sac, but also protect and repair the diseased arterial wall near the aneurysm neck because of the influence of parent artery and hemodynamic changes within the aneurysm, which can significantly reduce the recurrence rate of the aneurysm. But it is the key to successful treatment to choose different stents and fully understand the characteristics of each stent and method of operation based on the characteristics of each aneurysm and parent artery. The different stents have their own suitable objects, so it should make the personalization options. Multilayer stent should be used for blood blister-like aneurysm and dissecting aneurysm.
引文
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2. Rudin S, Wang Z, Kyprianou I, et al. Measurement of flow modification in phantom aneurysm model:comparison of coils and a longitudinally and axially asymmetric stent--initial findings. Radiology 2004; 231:272-276
3. Debrun GM, Aletich VA, Kehrli P, et al. Selection of cerebral aneurysms for treatment using Guglielmi detachable coils:the preliminary University of Illinois at Chicago experience. Neurosurgery 1998; 43:1281-1295; discussion 1296-1287
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5. Fernandez Zubillaga A, Guglielmi G, Vinuela F, et al. Endovascular occlusion of intracranial aneurysms with electrically detachable coils:correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 1994; 15:815-820
6. Clark TW, Sankin A, Becske T, et al. Stent-assisted Gugliemi detachable coil repair of wide-necked renal artery aneurysm using 3-D angiography. Vasc Endovascular Surg 2007; 41:528-532
7. Pandey AS, Koebbe C, Rosenwasser RH, et al. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms:review of a 10-year experience. Neurosurgery 2007; 60:626-636; discussion 636-627
8. Kan P, Siddiqui AH, Veznedaroglu E, et al. Early postmarket results after treatment of intracranial aneurysms with the pipeline embolization device:a U.S. multicenter experience. Neurosurgery 2012; 71:1080-1087; discussion 1087-1088
9. Lee WJ and Cho CS. Y-stenting endovascular treatment for ruptured intracranial aneurysms:a single-institution experience in Korea. J Korean Neurosurg Soc 2012; 52:187-192
10. Alurkar A, Karanam LS, Oak S, et al. Endovascular treatment of ruptured wide-necked basilar tip aneurysm with Y stenting and coiling in a case of bilateral internal carotid artery occlusion with moyamoya disease. Neurol India 2012; 60: 449-450
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1. Menghini VV, Brown RD, Jr., Sicks JD, et al. Incidence and prevalence of intracranial aneurysms and hemorrhage in Olmsted County, Minnesota,1965 to 1995. Neurology 1998; 51:405-411
2. Rudin S, Wang Z, Kyprianou I, et al. Measurement of flow modification in phantom aneurysm model:comparison of coils and a longitudinally and axially asymmetric stent-initial findings. Radiology 2004; 231:272-276
3. Debrun GM, Aletich VA, Kehrli P, et al. Selection of cerebral aneurysms for treatment using Guglielmi detachable coils:the preliminary University of Illinois at Chicago experience. Neurosurgery 1998; 43:1281-1295; discussion 1296-1287
4. Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms:a randomised trial. Lancet 2002; 360:1267-1274
5. Fernandez Zubillaga A, Guglielmi G, Vinuela F, et al. Endovascular occlusion of intracranial aneurysms with electrically detachable coils:correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 1994; 15:815-820
6. Clark TW, Sankin A, Becske T, et al. Stent-assisted Gugliemi detachable coil repair of wide-necked renal artery aneurysm using 3-D angiography. Vasc Endovascular Surg 2007; 41:528-532
7. Pandey AS, Koebbe C, Rosenwasser RH, et al. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms:review of a 10-year experience. Neurosurgery 2007; 60:626-636; discussion 636-627
8. Kan P, Siddiqui AH, Veznedaroglu E, et al. Early postmarket results after treatment of intracranial aneurysms with the pipeline embolization device:a U.S. multicenter experience. Neurosurgery 2012; 71:1080-1087; discussion 1087-1088
9. Lee WJ and Cho CS. Y-stenting endovascular treatment for ruptured intracranial aneurysms:a single-institution experience in Korea. J Korean Neurosurg Soc 2012; 52:187-192
10. Alurkar A, Karanam LS, Oak S, et al. Endovascular treatment of ruptured wide-necked basilar tip aneurysm with Y stenting and coiling in a case of bilateral internal carotid artery occlusion with moyamoya disease. Neurol India 2012; 60: 449-450
11. Gao B, Baharoglu MI, Cohen AD, et al. Y-stent coiling of basilar bifurcation aneurysms induces a dynamic angular vascular remodeling with alteration of the apical wall shear stress pattern. Neurosurgery 2013; 72:617-629; discussion 628-619
12. Zelenak K, Zelenakova J, DeRiggo J, et al. Flow changes after endovascular treatment of a wide-neck anterior communicating artery aneurysm by using X-configured kissing stents (cross-kissing stents) technique. Cardiovasc Intervent Radiol 2011;34:1308-1311
13. Fiorella D, Albuquerque FC, Woo H, et al. Neuroform in-stent stenosis:incidence, natural history, and treatment strategies. Neurosurgery 2006; 59:34-42; discussion 34-42
14. Krischek O, Miloslavski E, Fischer S, et al. A comparison of functional and physical properties of self-expanding intracranial stents [Neuroform3, Wingspan, Solitaire, Leo+, Enterprise]. Minim Invasive Neurosurg 2011; 54:21-28
15. Izar B, Rai A, Raghuram K, et al. Comparison of devices used for stent-assisted coiling of intracranial aneurysms. PLoS ONE 2011; 6:e24875
16. Lodi Y, Latorre J, El-Zammar Z, et al. Single Stage versus Multi-staged Stent-assisted Endovascular Repair of Intracranial Aneurysms. J Vasc Interv Neurol 2011; 4:24-28
17. Gao B and Malek AM. Possible mechanisms for delayed migration of the closed cell-designed enterprise stent when used in the adjunctive treatment of a basilar artery aneurysm. AJNR Am J Neuroradiol 2010; 31:E85-86
18. Lavine SD, Meyers PM, Connolly ES, et al. Spontaneous delayed proximal migration of enterprise stent after staged treatment of wide-necked basilar aneurysm: technical case report. Neurosurgery 2009; 64:E1012; discussion E1012
19. Lubicz B, Collignon L, Raphaeli G, et al. Solitaire stent for endovascular treatment of intracranial aneurysms:immediate and mid-term results in 15 patients with 17 aneurysms. J Neuroradiol 2010; 37:83-88
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