南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (08): 1165-.

• • 上一篇    

Willis覆膜支架治疗颈内动脉血泡样动脉瘤的临床效果

王刚,张国忠,李明洲,何小艳,刘丹,宋烨,漆松涛,冯文峰   

  • 出版日期:2016-08-20 发布日期:2016-08-20

Efficacy and safety of Willis covered stent for treatment of blood blister-like aneurysm

  • Online:2016-08-20 Published:2016-08-20

摘要: 目的应用Willis覆膜支架系统治疗颈内动脉血泡样动脉瘤,评估其安全性及有效性。方法2014年12月~2016年02月, 南方医科大学南方医院神经外科单纯采用颅内Willis覆膜支架系统,治疗8例颈内动脉血泡样动脉瘤。术中根据血管条件,在 保证载瘤动脉安全的前提下,尽可能将导引导管位置升高(靠近海绵窦段),提供足够支撑,覆膜支架到位后再予释放栓塞动脉 瘤。结果(1)对8例(8个血泡样动脉瘤)患者共置入9枚覆膜支架,其中8枚成功置入载瘤动脉。6例置入Willis支架后即刻造 影,显示病变完全消失,载瘤动脉通畅;1例置人1枚Willis支架后,有少量对比剂漏入动脉瘤(内漏),予再植入1枚覆膜支架,复 查造影动脉瘤完全不显影;(2)1例血泡样动脉瘤因颈内动脉迂曲,支架系统到位困难,术中发生医源性颈动脉海绵窦瘘(CCF), 球囊栓塞后予搭桥并载瘤动脉闭塞。术后患者因脑室外引流并发颅内感染,积极抗感染治疗后逐渐恢复;(3)术后6个月对8例 患者均行临床随访,mRS评分0分6例,1分2例。术后6个月DSA随访,动脉瘤均无复发,1例载瘤动脉轻度狭窄,但患者无神经 功能障碍,搭桥患者桥血管通畅。结论Willis覆膜支架是颈内动脉血泡样动脉瘤的有效治疗方法。

Abstract: Objective To evaluate the safety and short-term efficacy of Willis covered stent for treatment of blood blister-like aneurysms (BBA). Methods Eight patients with BBA were treated with Willis covered stent system during the period from December 2014 to February 2016. The guiding catheter was placed as high as possible to facilitate the delivery of the covered stent system. Results Nine covered stents were implanted in the aneurysms of 8 patients (8 aneurysms), and 8 stents were released successfully in the parent arteries. In 6 patients, angiography immediately after stent release showed complete disappearance of the aneurysm and the parent arteries remained patent. One patient experienced a minor endoleak after stent implantation, and another stent was implanted to eliminate the endoleak. Iatrogeniccarotid-cavernous fistula occurred in 1 patient due to tortuosity of the parent artery, for which superficial temporal artery-to-middle cerebral artery bypass combined with parent artery occlusion was performed instead; the patient recovered smoothly and the bypass remained patent at 6 months after the operation. No other periprocedural complications occurred in these patients. Follow-up study showed no new-onset neurological deficits in these 8 patients, who had mRS score of 0 in 6 patients and of 1 in 2 patients. Digital subtractive angiography at 6 months after the operation demonstrated no aneurysm in these patients, and only one patient showed mild stenosis in the parent artery. Conclusion Willis covered stents are effective for treatment of BBA with good safety and short-term outcomes.