A Study On Stents In The Treatment Of Complex Intracranial Aneurysms

Objective: Intracranial aneurysms, the main pathogeny that causes spontaneous subarachnoid hemorrhage, is a common disease in neurosurgery taking up about 85 percent. Vasospasm,its rebleeding and acute hydrocephalus caused by rupture hemorrhage of AN are life-threatening complications and in this kind of situation, mortality rate is higher, reaching to 25 percent to 60 percent. Clipping of intracranial aneurysm is a classical treatment method that has accurate effects. However, it has many obvious defects, such as serious operation trauma, with more difficulties and high risks.In recent years, endovascular coil treatment has been developed rapidly because of its minimally invasion feature and a mass of studies have demonstrated its accurate curative effect. However, it is difficult to embolize completely for complex aneurysms only with coiling or they cannot be treated in this way at all. With the development of intravascular therapy technology, indications of the treatment of intracranial aneurysms combining with stenting and coiling are more and more widely and it is definitely effective. Related studies make it clear that the mortality rate and disability rate of intravascular therapy is obviously lower than clipping, which is benefited from the development of advanced technology and new materials. Nowadays, more and more doctors and patients choose this kind of treatment for its minimally invasion and reliable effect. This paper reviews and analyzes cases that adopted stent to cure complex intracranial aneurysms, assessing the safety and effect of the treatment of intracranial aneurysms with stent.Methods: This paper collects 145 cases(152 in all) which use the treatment of intracranial aneurysms combining with stenting and coiling in department of neurosurgery of The Second Affiliated Hospital of Hebei Medical University. These cases were received and cured from October in 2013 to October in 2014. Then the paper summarizes and analyzes the final sate of patients, including their pathological features, image features, clearing up complications in operations, immediate angiographic results after operations, clinical state of hospital discharge and death. By studying angiography, the condition of the smoothness of parent artery after operations or follow-up visit, collateral vessels covered by stent and the condition of coverage of aneurysms intima in follow-up visit.Results: This group of cases use one film-covered stent, sixty-six Enterprises stents, forty-seven Solitaire stents and thirty-eight Lvis stents. 1 The safety of the treatment of aneurysms with stentThis group of cases include four that have technical complications during operations,two that have rupture of aneurysms(one death occurred)and two that have thrombus(one death occurred). 2 The imaging effect of the treatment of aneurysms with stent 2.1 The complete immediate embolism rate of aneurysms after operationsAmong 152 cases that imaging immediately after operations with stents, there are 126 cases are embolized completely, one case in which intima is covered completely by film-covered stent, 21 cases in which intimas is still remained and the other 4 intracranial aneurysms are treated only with stents.Among all cases, the complete embolism rate of tiny aneurysms is 80 percent, the rate of small aneurysms is 89.5 percent and the rate of large and giant aneurysms is 70.7 percent. 2.2 The results of short term imaging follow-up visitThe results of short term imaging follow-up visit shows that the complete embolism rate is 81.4 percent and there are no short term recurrence and stenosis in stents. 3 Clinical effect 3.1 Clinical effect of hospital dischargeAmong this group of cases, there are 3 death while in hospital. One case is that the patient died after operation for three hours because of artery hemorrhoea. One is caused by cerebral infraction after operation. The other one took operation successfully but died because of multiple organ failure caused by serious SAH. One case is that the patient had small area infraction and one side of body didn’t work well when leaving hospital. The other patients don’t have haemorrhage and ischemia. 122 cases have good clinical conditions when leaving hospital, which shows that the good clinical rate is 84.1 percent. 8 cases have mild disability(with 2 points of m RS) and 12 cases get more that 3 points. There are 3 death while in hospital and mortality rate is 2.06 percent. 3.2 The results of clinical follow-up visitAfter operations for 4 to 6 months, 130 patients in the cases get clinical follow-up visit at an average of 5.2 months. During the follow-up visit, three cases have complications and the rate is 2.3 percent. One patient gets a headache after operation and one gets communicating hydrocephalus and takes V-P bypass surgery after operation for 5months.Conclusions:1 The treatment of complex intracranial aneurysms combining with stenting and coiling is widely used for its minimally invasion, safety, convenience and effectiveness. Compared to surgical clipping, it has lower disability rate and mortality and gradually becomes the key method for complex intracranial aneurysms.2 Taking positive operative interventions is necessary for intracranial aneurysms(especially for rupturing one with irregular shape and fast speed swell), because the natural results are not optimistic.3 Making assessing before operations and making the operation specified in operations can decrease the rate of complications, thus satisfactory effects can be achieved.4 Stents tries to help the embolism be compact, slowing down the impact force to aneurysms caused by blood flow to reduce the recurrence rate of aneurysms.5 The treatment of intracranial aneurysms should be cautiously used for the patients whose HH are at 4 or5 level before operations, especially for those who have hematoncus in brains(or hernia of brain) and acute hydrocephalus.