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目的对颈内动脉(ICA)及椎动脉(VA)远端的颅内动脉瘤行覆膜支架植入治疗后即刻或迟发内漏及远期通畅性进行研究。方法对来自于3个中心的接受覆膜支架植入的41例病人的45个动脉瘤进行随访。观察指标包括动脉瘤闭塞率、内漏、远期支架内狭窄率、临床症状改善、神经系统缺陷及死亡。结果动脉瘤总体排除率达69.2%(n=27),其中30.8%(n=12)当时发生内漏残留。血管造影随访[平均(43.5±14.3)个月]显示87.2%(n=34)表现为完全闭塞,只有12.8%(n=5)可见内漏残留。即刻内漏的预测因素包括支架数量(P=0.023)和支架直径(P=0.022),而迟发内漏的预测因素为支架直径(P=0.035)和支架角度(P=0.021)。从植入后开始,随访第2年和第6年的晚期支架狭窄率分别为(18.0±13.3)%和(29.0±18.5)%。吸烟(P=0.017)和支架角度(P=0.020)是晚期支架狭窄的预测因素。结论覆膜支架在治疗颅内Willis环区域的动脉瘤方面具有可接受的即刻及晚期闭塞率和远期支架动脉通畅率。要点①覆膜支架可作为颅内动脉瘤治疗的选择方法。②治疗ICA和VA末端动脉瘤的技术成功率可达97.6%。③然而即刻及远期内漏的发生率分别为30.8%和12.8%。④支架数量、直径及角度是内漏发生的可能预测因素。⑤吸烟和支架角度似乎能够预测迟发支架内狭窄。
Objective To study the immediate or late endoleak and long-term patency of covered intracranial aneurysms of internal carotid artery (ICA) and vertebral artery (VA) after stent implantation. Methods Forty-five patients with 41 aneurysms implanted with stent-grafts from 3 centers were followed up. Observations included aneurysm occlusion, endoleak, long-term stent stenosis, improvement of clinical symptoms, neurological deficits and death. Results The overall aneurysm removal rate was 69.2% (n = 27), of which 30.8% (n = 12) left residual leakage at that time. Angiographic follow-up [mean (43.5 ± 14.3) months] showed complete occlusion in 87.2% (n = 34) and residual leakage in only 12.8% (n = 5). Predictors of immediate endoleak include stent volume (P = 0.023) and stent diameter (P = 0.022), while predictors of delayed endoleak are stent diameter (P = 0.035) and stent angle (P = 0.021). Late stent stenosis at the second year and the sixth year of follow-up were (18.0 ± 13.3)% and (29.0 ± 18.5)%, respectively. Smoking (P = 0.017) and stent angle (P = 0.020) were predictors of advanced stent stenosis. Conclusions Stent grafts have acceptable immediate and late occlusion rates and long-term stent patency in the treatment of aneurysms in the intracranial Willis ring region. Points ① covered stent can be used as a treatment of intracranial aneurysms choice. ② The technical success rate of ICA and VA terminal aneurysms is up to 97.6%. However, immediate and long-term leakage rates were 30.8% and 12.8%, respectively. ④ stent number, diameter and angle of leakage may occur predictors. ⑤ smoking and stent angle seems to be able to predict delayed stent stenosis.