LVIS支架不同释放方式在颅内宽颈动脉瘤中的应用

发布时间：2018-06-16 10:08

本文选题：颅内动脉瘤 + LVIS支架　；参考：《中国脑血管病杂志》2016年02期

【摘要】：目的探讨评估低剖面可视化腔内支撑装置(LVIS支架)"压缩"和"灯笼"释放方式治疗颅内宽颈动脉瘤的安全性及短期疗效。方法回顾性连续纳入2014年12月至2015年10月接受LVIS支架治疗且支架形态发生短缩改变的颅内宽颈动脉瘤患者15例(16个动脉瘤),均经全脑DSA检查明确诊断。"压缩"方式指通过操作使LVIS支架长度比标注释放数值短缩超过5 mm;"灯笼"方式指瘤颈处LVIS支架直径增宽。计算颈内动脉后交通段内支架压缩后金属覆盖率,并于术后即刻及术后3个月评价其安全性及疗效。结果 (1)采用LVIS支架辅助治疗的16个宽颈动脉瘤中后交通动脉瘤8个,眼动脉瘤6个,脉络膜前动脉瘤及大脑中动脉M2分叉梭形动脉瘤各1个;瘤颈1.8~8.0 mm,平均(3.9±1.7)mm;共置入LVIS支架15枚(1枚支架治疗两个动脉瘤者1例);均采用"压缩"方式释放支架,其中4例(4枚)同时并存"灯笼"方式。(2)LVIS支架术后Raymond分级Ⅰ级栓塞10个(62.5%),覆盖的分支动脉术后即刻均通畅。(3)围手术期未发生技术相关出血性和缺血性并发症,支架置入成功率100%(15/15)。(4)颈内动脉后交通段内支架压缩后金属覆盖率为30.3%~38.5%,平均(35.0±2.8)%。(5)15例LVIS支架置入术后患者均经全脑DSA随访3~5个月,平均(3.2±0.5)个月,其中14个动脉瘤达影像学治愈(RaymondⅠ级,87.5%),无动脉瘤复发病例。支架覆盖的所有分支动脉无闭塞,未发生支架内狭窄及载瘤动脉闭塞,总致残率为6.7%(1/15),无死亡病例。结论 LVIS支架通过"压缩"及"灯笼"方式可提高瘤颈金属覆盖率和短期治愈率,同时不影响覆盖的分支动脉。选择适宜病例行"灯笼"方式可能有利于瘤颈处分支动脉的短期保护。
[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.
【作者单位】：南京医科大学附属南京医院神经外科;南京医科大学附属南京医院介入血管科;
【分类号】：R651.12

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