RÉSUMÉ
Objective To explore the efficacy and safety of stent-assisted coil embolization of acutely ruptured wide-necked intracranial aneurysms. Methods One hundred and sixty patients with acutely ruptured wide-necked intracranial aneurysms (160 ruptured aneurysms), admitted to and underwent stent-assisted coil embolization in our hospital from January 201l to May 2018, were chosen. The clinical data, outcomes and complications of these patients were retrospectively analyzed. The differences of clinical data between patients with and without complications were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients. Univariate and multivariate Logistic regression analyses were conducted to analyze the risk factors of prognoses. Results All 160 stents were successfully released. Complete occlusion after endovascular procedures was achieved in 127 patients (79.4％); 17 aneurysms (10.6％) had neck residual and 16 aneurysms (10.0％) had aneurysm residual. Surgery-related complications occurred in 17 patients (10.6％), of which, 6 (3.8％) showed hemorrhagic events and 11 (6.9％) had ischemic events. The distributions of aneurysm sites between patients with ischemia related complications and those without ischemia related complications were statistically different (P<0.05). Poor prognosis was noted in 24 patients (15％) and good prognosis was noted in 136 (85％). The mRS scores, preoperative Hunt-Hess grades and distributions of stent types between patients with good prognosis and patients with poor prognosis were statistically different (P<0.05). Logistic regression analysis indicated that baseline mRS scores ≥4 (OR=39.000, 95％ CI:10.861-140.038, P=0.000), preoperative Hunt-Hess grading IV-V (OR=13.000, 95％CI: 4.063-41.596, P=0.015), and Solitaire stents placement (OR=3.333, 95％CI: 1.332-8.339, P=0.028) were the independent risk factors for poor clinical outcomes in patients with acutely ruptured wide-necked intracranial aneurysms. Conclusion Stent-assisted coil embolization is suggested to be a safe and efficacious way to treat acutely ruptured wide-necked intracranial aneurysms, and patients with baseline mRS scores≥4, preoperative Hunt-Hess grading IV-V and Solitaire stents placement are more prone to having poor clinical outcomes.
RÉSUMÉ
Objective To investigate the safety and short-term efficacy for evaluation of the low-profile visualized intraluminal support device (LVIS stents )compression and lantern release shapes for the treatment of wide-necked intracranial aneurysms. Methods From December 2014 to October 2015,15 patients with intracranial wide-neck aneurysm (16 aneurysms)received LVIS stent treatment, whose stent shapes had shortening changes were analyzed retrospectively. Thecompression mode refers to the length of LVIS stent to be shorter for more than 5 mm than the label release value by operation. Thelantern mode refers to the widened diameter of LVIS stent at the neck of aneurysm. The metal coverage rate in the posterior communicating segment of internal carotid artery after stent compression was calculated, and its safety and efficacy were assessed immediately after procedure and at 3 months after procedure. Results (1 )Using LVIS stent-assisted treatment,16 wide-necked aneurysms were treated,including 8 posterior communicating aneurysms,6 ophthalmic aneurysms,one anterior choroidal artery aneurysm and one M2 bifurcation fusiform aneurysm. The aneurysm neck was 1. 8 to 8. 0 mm (mean 3. 9 ± 1. 7 mm). A total of 15 LVIS stents were implanted (one patient with 2 aneurysms were treated with 1 stent). All the stents were released by using compression mode,and 4 of the patients (4 stents)also used the lantern mode at the same time. (2 ) After LVIS stenting,the Raymond grade Ⅰ embolization was in 10 aneurysms (62.5%),the covered branch arteries were patent immediately after procedure. (3)No perioperative technology-related hemorrhagic and ischemic complications occurred. The success rate of stent implantation was 100%(15/15). (4)The metal coverage rate after stent compression in the internal carotid artery posterior communicating segment was 30. 3%-38. 5%(mean 35. 0 ± 2. 8%). (5)After LVIS stent implantation,15 patients were followed up by whole brain DSA for 3 to 5 months (mean 3. 2 ± 0. 5), 14 aneurysms were cured on imaging (Raymond gradeⅠ),and no aneurysm recurred. All branch arteries covered by the stents did not have vascular occlusion. There was no in-stent restenosis or parent artery occlusion. The total disability rate was 6. 7%(1/15),and no patient died. Conclusions LVIS stents can increase aneurysm neck metal coverage rate and short-term cure rate throughcompression andlantern modes,while does not affect the covered branches. Choosing the appropriate cases for thelanternmode may be beneficial to the short-term protection of the vascular branches at the aneurysm necks.