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目的观察采用颅内专用覆膜支架及其输送系统通过颅段颈内动脉(CICA)骨性管道和生理弯曲,治疗颅段颈内动脉病变的效果。方法采用颅内专用覆膜支架,以血管内技术治疗13例 CICA 病变。其中巨大假性动脉瘤4例、巨大动脉瘤4例、宽颈小动脉瘤3例、巨大假性动脉瘤伴颈动脉海绵窦瘘(CCF)1例、CCF 1例。颅内专用覆膜支架释放前均行患侧颈内动脉球囊闭塞试验(BOT)和 DSA。术后3～16个月施行 DSA 随访和临床随访。结果 13例患者 BOT 均耐受良好,DSA证实前、后交通动脉开放良好。13例覆膜支架及其输送系统均顺利通过 CICA 到达病变靶区。病变及覆膜支架释放部位分别为:C3～4段4例、C4～5段4例、C6～7段5例。覆膜支架释放后即刻 DSA示7例动脉瘤不再显影,4例显示少量内漏,1例 CCF 覆膜支架释放后流量明显减少,1例假性动脉瘤伴 CCF 覆膜支架释放后动脉瘤消失,但残存低流量 CCF。13例中1例动脉瘤破裂性蛛网膜下腔出血患者术后9 d 因血管广泛痉挛而死亡。12例随访 DSA 均显示覆膜支架放置处血管通畅,其中2例显示轻度狭窄;6例术后存在内漏,其中4例 DSA 随访7～16个月后内漏消失,1例再次置入覆膜支架治疗后内漏消失;1例 CCF,3个月后随访仍显示低流量瘘。存活患者临床随访3～16个月未发生支架覆盖段相关分支堵塞后的并发症。结论颅内覆膜支架及其输送系统的柔顺性足以使其通过迂曲的 CICA,到达颅内病变血管处,有效治疗 CICA 病变。颅内覆膜支架的远期疗效有待长期随访,其贴壁性能仍需进一步完善。
Objective To observe the effect of intracranial stent-graft and its delivery system on the intracranial internal carotid artery lesions by means of the CICA bony duct and physiological curve. Methods Intracranial stent-graft was used to treat 13 CICA lesions by intravascular technique. There were 4 cases of huge pseudoaneurysm, 4 cases of giant aneurysm, 3 cases of wide-necked small aneurysm, 1 case of huge pseudoaneurysm with carotid cavernous fistula (CCF) and 1 case of CCF. Intracranial endoprosthesis stent dissection before the ipsilateral carotid artery balloon occlusion (BOT) and DSA. Postoperative 3 to 16 months of DSA follow-up and clinical follow-up. Results All the 13 patients were well tolerated with BOT, and the DSA confirmed that the traffic artery was open well before and after the operation. Thirteen stent-graft and its delivery system successfully passed the CICA to reach the lesion target. Lesions and stent-graft sites were: C3 ~ 4 in 4 cases, C4 ~ 5 in 4 cases, C6 ~ 7 in 5 cases. DSA showed no aneurysm development in 7 cases immediately after stent graft release, 4 cases showed a small amount of endoleak, and the flow rate of 1 case of CCF stent was significantly reduced after release. The aneurysm disappeared in 1 case of pseudoaneurysm with CCF covered stent , But the residual low-flow CCF. One of 13 patients with aneurysm ruptured subarachnoid hemorrhage died due to extensive vasospasm 9 days after operation. Twelve follow-up DSA showed that the stents were placed with vascular patency, two of them showed mild stenosis. Six patients had endoleaks after operation, of which four had disappearance of endoleak after seven to 16 months of follow-up and one had re-implantation Ligament stent treatment disappeared; 1 case of CCF, 3 months after follow-up showed low-flow fistula. Survival patients with clinical follow-up of 3 to 16 months did not occur after stent-graft-related complications of branch blockage. Conclusions The flexibility of intracranial stent and its delivery system is sufficient to make it reach the intracranial vascular site through tortuous CICA and effectively treat CICA lesions. The long-term follow-up of the intracranial stent-graft remains to be followed up, and its adherence needs to be further improved.