本文選題：顱內(nèi)動(dòng)脈瘤 + LVIS支架��； 參考：《中國(guó)腦血管病雜志》2016年02期

【摘要】：目的探討評(píng)估低剖面可視化腔內(nèi)支撐裝置(LVIS支架)"壓縮"和"燈籠"釋放方式治療顱內(nèi)寬頸動(dòng)脈瘤的安全性及短期療效。方法回顧性連續(xù)納入2014年12月至2015年10月接受LVIS支架治療且支架形態(tài)發(fā)生短縮改變的顱內(nèi)寬頸動(dòng)脈瘤患者15例(16個(gè)動(dòng)脈瘤),均經(jīng)全腦DSA檢查明確診斷。"壓縮"方式指通過(guò)操作使LVIS支架長(zhǎng)度比標(biāo)注釋放數(shù)值短縮超過(guò)5 mm;"燈籠"方式指瘤頸處LVIS支架直徑增寬。計(jì)算頸內(nèi)動(dòng)脈后交通段內(nèi)支架壓縮后金屬覆蓋率,并于術(shù)后即刻及術(shù)后3個(gè)月評(píng)價(jià)其安全性及療效。結(jié)果 (1)采用LVIS支架輔助治療的16個(gè)寬頸動(dòng)脈瘤中后交通動(dòng)脈瘤8個(gè),眼動(dòng)脈瘤6個(gè),脈絡(luò)膜前動(dòng)脈瘤及大腦中動(dòng)脈M2分叉梭形動(dòng)脈瘤各1個(gè);瘤頸1.8~8.0 mm,平均(3.9±1.7)mm;共置入LVIS支架15枚(1枚支架治療兩個(gè)動(dòng)脈瘤者1例);均采用"壓縮"方式釋放支架,其中4例(4枚)同時(shí)并存"燈籠"方式。(2)LVIS支架術(shù)后Raymond分級(jí)Ⅰ級(jí)栓塞10個(gè)(62.5%),覆蓋的分支動(dòng)脈術(shù)后即刻均通暢。(3)圍手術(shù)期未發(fā)生技術(shù)相關(guān)出血性和缺血性并發(fā)癥,支架置入成功率100%(15/15)。(4)頸內(nèi)動(dòng)脈后交通段內(nèi)支架壓縮后金屬覆蓋率為30.3%~38.5%,平均(35.0±2.8)%。(5)15例LVIS支架置入術(shù)后患者均經(jīng)全腦DSA隨訪3~5個(gè)月,平均(3.2±0.5)個(gè)月,其中14個(gè)動(dòng)脈瘤達(dá)影像學(xué)治愈(RaymondⅠ級(jí),87.5%),無(wú)動(dòng)脈瘤復(fù)發(fā)病例。支架覆蓋的所有分支動(dòng)脈無(wú)閉塞,未發(fā)生支架內(nèi)狹窄及載瘤動(dòng)脈閉塞,總致殘率為6.7%(1/15),無(wú)死亡病例。結(jié)論 LVIS支架通過(guò)"壓縮"及"燈籠"方式可提高瘤頸金屬覆蓋率和短期治愈率,同時(shí)不影響覆蓋的分支動(dòng)脈。選擇適宜病例行"燈籠"方式可能有利于瘤頸處分支動(dòng)脈的短期保護(hù)。
[Abstract]:Objective to evaluate the safety and short-term efficacy of a low profile visual intracavity support device (LVIS stent) "compression" and "lantern" release for the treatment of intracranial wide necked aneurysm. Methods 15 cases of intracranial wide necked aneurysms with LVIS stent treatment and short contraction of stent morphogenesis from December 2014 to October 2015 were retrospectively reviewed. All the aneurysms were diagnosed by the whole brain DSA examination. "Compression" means that the length of the LVIS stent is shorter than 5 mm by operation. "Lantern" means the width of the LVIS stent in the neck of the tumor. The metal cover rate after the stent is compressed in the posterior segment of the internal carotid artery is calculated, and the safety is evaluated immediately after the operation and 3 months after the operation. Results (1) there were 8 posterior communicating aneurysms in 16 wide necked aneurysms with LVIS stent assisted treatment, 6 ophthalmic aneurysms, 1 anterior choroidal aneurysms and 1 M2 branched spindle aneurysms in the middle cerebral artery, and 1.8~8.0 mm of the tumor neck (3.9 + 1.7) mm; a total of 15 (1 stent for two aneurysms) were placed (1 stent for two aneurysms). 4 cases (4) coexist with "lantern" mode. (2) 10 (62.5%) of Raymond grade I embolism after LVIS stenting, and the covered branch artery was unobstructed immediately after the branch artery operation. (3) there was no technical related hemorrhagic and ischemic complication in the perioperative period, the success rate of stent implantation was 100% (15/15). (4) internal branch of posterior internal carotid artery After compression, the metal coverage was 30.3%~38.5%, average (35 + 2.8)%. (5) 15 cases of LVIS stent implantation were followed up for 3~5 months, average (3.2 + 0.5) months, of which 14 aneurysms were cured (Raymond grade I, 87.5%), no aneurysm recurrent cases. The stent covered all branch arteries were not occluded and did not occur within the stent. The total disability rate of stenosis and aneurysm artery occlusion was 6.7% (1/15) and no death cases. Conclusion LVIS stent can improve the metal coverage and short-term cure rate of tumor neck by "compression" and "lantern" method, without affecting the covered branch artery. The choice of suitable "lantern" method may be beneficial to the short term protection of the branch of the tumor neck.
【作者單位】： 南京醫(yī)科大學(xué)附屬南京醫(yī)院神經(jīng)外科;南京醫(yī)科大學(xué)附屬南京醫(yī)院介入血管科;
【分類號(hào)】：R651.12

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