编织支架辅助弹簧圈栓塞大脑中动脉宽颈动脉瘤的疗效分析

目的探讨编织支架辅助弹簧圈栓塞治疗大脑中动脉宽颈动脉瘤的安全性和有效性。方法回顾性分析2016年7月—2020年7月南京医科大学附属南京医院采用LVIS编织支架辅助栓塞技术治疗的51例大脑中动脉宽颈动脉瘤患者的临床资料，分析患者的预后情况。结果术后即刻DSA显示Raymond分级Ⅰ级致密栓塞38例(74.51%)，Ⅱ级瘤颈残余10例(19.61%)，Ⅲ级瘤体残余3例(5.88%)。6例并发症，均为破裂大脑中动脉瘤患者。其中1例为术后再出血，1例术后脑肿胀，1例术中出血。3例为术中缺血性相关并发症，其中1例为血栓事件。术后mRS评分50例患者预后良好(mRS评分≤3分)。50例患者术后随访6~12个月均行DSA复查，无复发。结论编织支架辅助弹簧圈治疗大脑中动脉宽颈动脉瘤是安全且有效的，但破裂动脉瘤的围手术并发症发生率仍不可忽视。

Objective To explore the safety and efficacy of braided stent embolization with spring coil for middle cerebral artery wide-neck aneurysm. Methods The clinical data of 51 patients with middle cerebral artery wide-neck aneurysm treated with braided stent-assisted embolization in Nanjing First Hospital Affiliated to Nanjing Medical University from July 2016 to July 2020 were retrospectively analyzed. Results Immediate postoperative DSA showed that there were 38 cases of Raymond grade 1 dense embolism, 10 cases of Grade 2 loose embolism, and 3 cases of grade 3 partial embolism. The complications were all ruptured middle cerebral aneurysm in 6 patients. Among them, 1 case was postoperative rebleeding,1 case was postoperative brain swelling, and 1 case was intraoperative bleeding. 3 cases were ischemic related complications, including 1 case of thrombosis. With postoperative mRS score, 50 patients had a good prognosis(mRS score ≤3). 50 patients were followed up from 6 months to 12 months after operation for annual DSA review, no recurrence. Conclusion Braided stent coils are safe and effective in the treatment of wide neck middle cerebral artery aneurysms, but the incidence of perioperative complications of ruptured aneurysms should not be ignored.