Y-configured dual intracranial stent-assisted coil embolization for the treatment of wide-necked basilar tip aneurysms
Y-configured dual intracranial stent-assisted coil embolization for the treatment of wide-necked basilar tip aneurysms
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DOI：
10.1227/01.neu.0000158308.25115.fd
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发表时间：
2005-05-01
期刊：
影响因子：
4.8
通讯作者：
Rasmussen, PA
中科院分区：
文献类型：
--
作者：
Thorell, WE;Chow, MM;Rasmussen, PA
目的：尽管在手术和血管内治疗颅内动脉瘤方面都取得了进展，但宽颈基底动脉顶端动脉瘤(即两侧大脑后动脉从宽颈动脉瘤底部发出的动脉瘤)是动脉瘤的一个亚类，在治疗中仍面临着技术挑战。方法：在大脑后动脉和基底动脉放置两个Neuroform支架(Boston Science/Target，Fremont，CA)，一个以Y形穿过另一个的间隙，从而在保留载瘤血管的情况下重建动脉瘤颈并实现安全的弹簧圈输送。结果：7例未破裂、无症状的宽颈基底动脉顶端动脉瘤，直径7~20 mm，均采用支架辅助弹簧圈技术治疗。其中6例患者成功置入2个支架，第7例患者成功置入1个支架。一名患者出现一过性核间眼肌麻痹，另一名患者出现一过性右眼部分动眼神经麻痹。所有的动脉瘤都进行了完全或接近完全的栓塞术。治疗后6个月(6例)和1年(1例)血管造影显示1例线圈致密、轻度再通，另1例血管再通需要再治疗。所有患者在首次手术和随后的手术后至少6个月神经学上完好无损，没有蛛网膜下腔出血的临床迹象。结论：这些初步的技术和临床结果是非常令人鼓舞的，这项技术可能会显著提高颅内动脉瘤的血管内治疗。
OBJECTIVE: Despite advances in both the surgical and endovascular treatment of intracranial aneurysms, wide-necked basilar tip aneurysms (i.e., basilar tip aneurysms in which both posterior cerebral arteries emanate from the base of a wide-necked aneurysm) represent a subset of aneurysms that continues to pose technical challenges in treatment. We sought to demonstrate the safety and short-term durability of a novel dual stent-assisted coil embolization technique.METHODS: Two Neuroform stents (Boston Scientific/Target, Fremont, CA) were deployed in the posterior cerebral arteries and the basilar artery, one passing through the interstices of the other in a Y-configuration, thereby recreating an aneurysm neck and enabling safe coil delivery while preserving the parent vessels.RESULTS: Seven patients with unruptured, asymptomatic, wide-necked basilar tip aneurysms involving both posterior cerebral arteries and ranging in size from 7 to 20 mm underwent treatment with this stent-assisted coiling technique. Two stents were successfully deployed in six of the patients and one stent was successfully deployed in the seventh. One patient developed a transient internuclear ophthalmoplegia, and another experienced transient partial right oculomotor nerve palsy. All aneurysms had complete or near- complete embolization with the, initial procedure. Follow-up angiography performed 6 months (six patients) and 1 year (one patient) after treatment demonstrated coil compaction and slight recanalization in one,patient and recanalization requiring retreatment in another. All patients were neurologically intact at least 6 months after the initial procedure, as well as subsequent procedures, without clinical signs of subarachnoid hemorrhage.CONCLUSION: These initial technical and clinical results are highly encouraging, and this technique may significantly improve the endovascular treatment of intracranial aneurysms.