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| LVIS支架辅助栓塞宽颈脉络膜前动脉动脉瘤疗效分析 |
| 刘建武1,2,祝斐3,陈志华2,宋书欣2,祝新根2,朱健明2* |
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(1. 赣州市人民医院神经外科, 赣州 341000;
2. 南昌大学第二附属医院神经外科, 南昌 330000;
3. 中国人民解放军联勤保障部队庐山康复疗养中心神经外科, 九江 332000
*通信作者) |
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| 摘要: |
| 目的 分析低剖面可视化腔内支撑装置（LVIS）辅助栓塞脉络膜前动脉动脉瘤的安全性及治疗效果。方法 回顾性分析南昌大学第二附属医院2015年1月至2019年1月行LVIS支架辅助栓塞治疗的31例宽颈脉络膜前动脉动脉瘤患者的临床资料及随访结果。采用颅脑数字减影血管造影（DSA）和Raymond分级评价栓塞效果，以改良Rankin量表（mRS）评分评价预后。结果 31例宽颈脉络膜前动脉动脉瘤患者中，破裂动脉瘤22例，未破动脉瘤9例，LVIS支架辅助栓塞术均获得成功。栓塞术后即刻颅脑DSA结果显示，Raymond分级Ⅰ级25例（完全栓塞），Ⅱ级（次全栓塞）4例，Ⅲ级（部分栓塞）2例，载瘤动脉均通畅；术后发生缺血并发症4例。术后6~9个月复查颅脑DSA，Raymond分级Ⅰ级27例，Ⅱ级3例，Ⅲ级1例；1例患者脉络膜前动脉轻度狭窄，余脉络膜前动脉均无明显狭窄或闭塞。29例预后良好（mRS评分≤ 2分），2例患者预后不良（mRS评分均为3分）。破裂组与未破组患者术后缺血并发症发生率、术后6~9个月完全闭塞率及预后良好率差异均无统计学意义（P均>0.05）。所有患者术后及随访期间均未发生再出血，均未进行再治疗。结论 LVIS支架辅助栓塞宽颈脉络膜前动脉动脉瘤安全、有效，破裂组与未破裂组疗效无明显差异，但仍需更大样本、多中心研究及长期随访进一步验证。 |
| 关键词: 脉络膜前动脉动脉瘤 宽颈动脉瘤 LVIS支架 治疗性栓塞 |
| DOI：10.16781/j.CN31-2187/R.20190718 |
| 投稿时间：2019-08-03修订日期：2021-03-21 |
| 基金项目: |
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| LVIS stent-assisted embolization of wide-necked anterior choroidal artery aneurysms: an analysis of efficacy |
| LIU Jian-wu1,2,ZHU Fei3,CHEN Zhi-hua2,SONG Shu-xin2,ZHU Xin-gen2,ZHU Jian-ming2* |
(1. Department of Neurosurgery, The People's Hospital of Ganzhou, Ganzhou 341000, Jiangxi, China;
2. Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi, China;
3. Department of Neurosurgery, Lushan Rehabilitation and Recuperation Center of Joint Logistics Support Force of PLA, Jiujiang 332000, Jiangxi, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted embolization for the anterior choroidal artery aneurysms. Methods The clinical and follow-up data of 31 patients with wide-necked anterior choroidal artery aneurysms who received LVIS stent-assisted embolization therapy in The Second Affiliated Hospital of Nanchang University from Jan. 2015 to Jan. 2019 were retrospectively analyzed. Cerebral digital subtraction angiography (DSA) and Raymond classification were used to evaluate the embolization effect, and modified Rankin scale (mRS) score was used to evaluate the prognosis. Results All the 31 patients with wide-necked anterior choroidal artery aneurysms (including 22 cases of ruptured aneurysms and 9 cases of non-ruptured aneurysms) were successfully treated with LVIS stent-assisted embolization. The results of DSA immediately after embolization showed that 25 aneurysms were presented with Raymond grade Ⅰ (complete occlusion), 4 with grade Ⅱ (subtotal occlusion) and 2 with grade Ⅲ (partial occlusion), parent arteries were unobstructed, and ischemic complications occurred in 4 cases. The results of DSA 6-9 months after embolization showed that 27 aneurysms were Raymond grade Ⅰ, 3 grade Ⅱ and 1 grade Ⅲ, 1 case had a mild stenosis of anterior choroidal artery, and no significant stenosis or occlusion was found in the remaining parent arteries. Twenty-nine patients had a good prognosis (mRS score ≤ 2), and 2 patients had a poor prognosis (mRS score was 3). There was no significant difference in postoperative ischemic complication incidence, complete occlusion rate or good prognosis rate 6-9 months after embolization between ruptured and non-ruptured groups (all P>0.05). No rebleeding or retreatment occured during follow-up. Conclusion LVIS stent-assisted embolization of wide-necked anterior choroidal artery aneurysms is safe and effective, showing no significant difference between ruptured and non-ruptured groups, however, it still needs to be further verified by multicenter trials with large samples and long-term follow-up. |
| Key words: anterior choroidal artery aneurysms wide-necked aneurysms LVIS stent therapeutic embolization |
