LVIS支架辅助栓塞颅内微小动脉瘤的安全性及疗效分析

Analysis of Safety and Efficacy of LVIS Stent Assisted Embolization for Intracranial Microaneurysm

摘要: 目的：分析使用LVIS支架辅助栓塞颅内微小动脉瘤的安全性和疗效。方法：回顾性分析了2017年1月至2019年12月使用LVIS支架辅助治疗的23例颅内微小动脉瘤患者临床及随访资料，分析术中并发症、手术效果及预后随访情况。结果：23例颅内微小动脉瘤患者均使用LVIS支架辅助弹簧圈栓塞。23例患者共使用LVIS支架25枚，1例患者置入了双支架，1例患者为2枚颅内微小动脉瘤，置入了两枚支架，支架释放成功率达100%。术中动脉瘤破裂出血1例(4.3%)，1例患者出现支架内血栓形成(4.3%)。术后即刻造影，Raymond I级栓塞16枚(66.7%)，Raymond II级栓塞6枚(25%)，Raymond III级栓塞2枚(8.3%)，围手术期未再发生脑出血及脑梗死情况；随访3月至1年，所有患者均复查造影，Raymond I级栓塞22枚(91.7%)，Raymond II级栓塞2枚(8.3%)，所有LVIS支架均展开良好，无支架移位、分支血管闭塞及血管狭窄情况。随访期间患者mRS评分0分21例，mRS评分2分1例，mRS评分3分1例，预后良好率达到96% (mRS评分0~2分)。结论：LVIS支架辅助栓塞颅内微小动脉瘤是安全有效的方法，能提高动脉瘤治愈率，近期治疗效果良好，但要求术者需具备良好的支架应用技巧，远期疗效仍需多中心、大样本及长时间的随访观察。

Abstract: Objective: To analyze the safety and efficacy of LVIS stent assisted embolization for intracranial microaneurysm. Method: Retrospective analysis was performed on the clinical and follow-up data of 23 patients with intracranial microaneurysms who underwent LVIS stent assisted embolization from January 2017 to December 2019, and the intraoperative complications, surgical effect and prognosis were analyzed. Result: All the 23 patients with intracranial microaneurysm underwent LVIS assisted coil embolization. Twenty five LVIS stents were used in 23 patients; 1 patient received dual LVIS stent; two stents were implanted in one patient with 2 intracranial microaneurysms. The success rate of stent release was 100%. There was one case of intraoperative aneurysm rupture and hemorrhage (4.3%). One case developed stent thrombosis (4.3%). Immediate postoperative angiography showed that 16 (66.7%) microaneurysms achieved Raymond grade I embolization; 6 (25%) microaneurysms achieved Raymond grade II embolization; 2 (8.3%) microaneurysms achieved Raymond grade III embolization. There was no cerebral hemorrhage and cerebral infarction in perioperative period. The follow-up time was 3 months to 1 year. All patients were reexamined angiography during follow-up. 22 (91.7%) microaneurysms achieved Raymond grade I embolization. 2 (8.3%) microaneurysms achieved Raymond grade II embolization. All LVIS stents were well deployed without stent displacement, branch vessel occlusion and vascular stenosis. During the follow-up period, the mRS score was 0 in 21 cases; the mRS score was 2 in 1 cases; the mRS score was 3 in 1 cases; the favorable prognosis (with the mRS score at 0 - 2) rate reached 96%. Conclusion: LVIS stent assisted embolization for intracranial microaneurysms is a safe and effective method. It can improve the cure rate of aneurysm, and the short-term treatment effect is good, but it is required that the operator should have good stent application skills, and the long-term efficacy still needs multi center, large sample and long term follow-up.