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目的探讨支架和球囊辅助瘤颈重塑技术治疗颅内宽颈动脉瘤栓塞的疗效。方法将26例颅内宽颈动脉瘤患者按手术方法分为支架辅助组(19例)和球嚢辅助组(7例)。对于体/颈比<2而>1的动脉瘤,选择球嚢辅助瘤颈重塑技术进行动脉瘤弹簧圈栓塞术;对于体/颈比<1或瘤颈过于宽大的动脉瘤,选择支架辅助瘤颈重塑技术进行动脉瘤弹簧圈栓塞术。术后3个月对2组患者的预后进行改良Rankin量表评分,术后6个月复查数字减影血管造影技术(DSA),观察预后良好率和复发率。结果支架辅助组19例患者,动脉瘤完全栓塞12例,次全栓塞7例;球嚢辅助组7例患者,动脉瘤完全栓塞4例,次全栓塞2例,部分栓塞1例。所有病例手术均成功,无动脉瘤破裂出血。2组患者均进行3-6个月的随访,术后3个月改良Rankin量表评分,支架辅助组0分16例,1分2例,2分1例,预后良好率为84.2%;球嚢辅助组0分6例,1分1例,预后良好率为85.7%。术后6个月支架辅助组13例患者复查DSA,11例影像学稳定,2例次全栓塞转为完全栓塞,载瘤动脉均通畅,支架未见移位;球嚢辅助组5例患者复查DSA,4例影像学稳定,1例有瘤颈残留。2组均无死亡病例,无再出血发生。结论支架和球囊辅助瘤颈重塑结合弹簧圈栓塞均是治疗颅内宽颈动脉瘤安全、有效的方法。
Objective To investigate the curative effect of stent and balloon-assisted neck reconstruction in the treatment of intracranial wide-necked aneurysm embolism. Methods Twenty - six patients with wide - necked intracranial aneurysm were divided into two groups: scaffold group (n = 19) and bulb group (n = 7). For aneurysms with a body / neck ratio <2 and> 1, balloon-assisted neoplasia remodeling is selected for aneurysm coil embolization; for aneurysms with an excessively large body / neck ratio <1 or neoplasm, stent-assisted Aneurysm embolization with aneurysm revascularization technique. Three months after operation, the prognosis of two groups was assessed by Rankin scale. The digital subtraction angiography (DSA) was performed 6 months after the operation. The good prognosis and recurrence rate were observed. Results In the 19 cases of stent-assisted group, there were 12 cases of complete aneurysm embolization and 7 cases of sub-total embolization. In the balloon-assisted group, 7 cases were complete embolization of aneurysm, 2 cases of sub-total embolization and 1 case of partial embolization. All cases were successful in surgery, no aneurysm rupture bleeding. The patients in both groups were followed up for 3-6 months. The modified Rankin scale was obtained at 3 months after operation. There were 0 cases in 16 cases, 1 case in 2 cases and 1 case in 2 cases. The good prognosis rate was 84.2%嚢 auxiliary group 0 points in 6 cases, 1 in 1 case, good prognosis was 85.7%. Thirteen patients in the stent-assisted group at 6 months after operation were retrospectively reviewed. DSA was performed in 11 patients. Radiographic evaluation was performed in 2 patients with complete thrombo-embolization. The parent artery was unobstructed and the stent was not displaced. DSA, 4 cases of stable imaging, 1 case of tumor residual neck. No deaths were found in both groups and no further bleeding occurred. Conclusion Stent and balloon-assisted neck reconstruction combined with coil embolization are both safe and effective in the treatment of wide-necked intracranial aneurysms.