Zhongguo cuzhong zazhi (Aug 2018)
LVIS支架在颅内动脉瘤治疗中的安全性及有效性的单中心观察性研究 Safety and Effectiveness of the Low Profile Visualized Intraluminal Support Devices in the Endovascular Treatment of Intracranial Aneurysms: A Single-Center Retrospective Analysis
Abstract
目的 探讨LVIS支架在囊状动脉瘤、夹层动脉瘤支架辅助栓塞术中的安全性及有效性。 方法 回顾性纳入中国人民解放军总医院神经内科2016年7月-2017年7月收治的71例应用LVIS支架 行动脉瘤支架辅助栓塞的颅内动脉瘤患者。根据数字减影血管造影（digital subtraction angiography， DSA）术后即刻图像及复查DSA图像，评估LVIS支架在动脉瘤支架辅助术中的安全性及有效性。 结果 71例颅内动脉瘤患者中，破裂动脉瘤20个（28.2%），未破裂51个（71.8%）；前循环动脉瘤56 个（78.9%），后循环动脉瘤15个（21.1%）；术中血栓事件4例（5.6%）。栓塞后即刻改良Raymond分 级：1级39个（54.9%），2级13个（18.3%），3a级11个（15.5%），3b级8个（11.2%）；其中破裂动脉瘤改 良Raymond分级1级14个（70.0%），未破裂动脉瘤改良Raymond分级1级25个（49.0%），前循环动脉瘤 改良Raymond分级1级33个（58.9%），后循环动脉瘤改良Raymond分级1级6个（40.0%）。术后半年DSA 复查29例（40.8%），其中改良Raymond分级较栓塞后即刻造影级别改善7个，占2级、3级动脉瘤（32个） 40.6%（3b级→1级4个，3a级→1级1个，2级→1级2个），变差2个（2级→3a级1个，2级→3b级1个）。术中 发生血栓事件共4例（5.6%），术后复查DSA发现载瘤动脉狭窄2例，占复查例数6.8%。 结论 LVIS支架在颅内动脉瘤支架辅助栓塞术中安全、有效，但术中血栓事件及术后载瘤动脉再狭 窄亦应引起重视。 Abstract: Objective To investigate the safety and effectiveness of the low profile visualized intraluminal support (LVIS) devices in stent-assisted coil embolization of intracranial saccular aneurysms and dissecting aneurysms. Methods 71 patients with intracranial aneurysms treated with stent-assisted coil embolization using LVIS devices in department of neurology in PLA general hospital from July 2016 to July 2017 were consecutively included in this study. The digital subtraction angiography (DSA) immediately after the procedure and at 6-month fowllow-up were reviewed to evaluate the safety and effectiveness of the LVIS devices in the treatment of intracranial aneurysms. Results Among all 71 patients, 20 (28.2%) cases with ruptured aneurysms and 51 (71.8%) with unruptured aneurysms, 56 (78.9%) cases with anterior circulation aneurysms and 15 (21.1%) cases with posterior circulation aneurysms. Thrombotic events occurred in 4 (5.6%) cases during the treatment. Immediate angiography after the embolization, the results of modified Raymond scale showed that 39 (54.9%) grade I, 13 (18.3%) grade II, 11 (15.5%) grade IIIa and 8 (11.2%) grade IIIb. The modified Raymond grade I occlusion were achieved in the following aneurysms: 14 (70.0%) ruptured aneurysms, 25 (49.0%) unruptured aneurysms, 33 (58.9%) anterior circulation aneurysms and 6 (40.0%) posterior circulation aneurysms. 29 (40.8%) patients were reassessed with DSA at 6-month follow-up, comparing with immediate angiography after the embolization, the modified Raymond grade improved in 7 aneurysms (4 Raymond IIIb to I, 1 Raymond IIIa to I, 2 Raymond II to I) and the angiography got worse in 2 aneurysms (1 Raymond II to IIIa and 1 II to IIIb). Thrombotic events occurred in 4 (5.6%) patients during the surgery, and in-stent restenosis occurred in 2 (6.8%) patients in DSA reexamination after the embolization. Conclusions The LVIS endovascular devices are safe and effective in the treatment of intracranial aneurysms. However, immediate thrombosis during operation and delayed in-stent stenosis should be paid more attention.
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