Stent-assisted Coiling Embolization Of Small Wide-necked Aneurysms In Internal Carotid Artery

Objective:Objective to explore the feasibility and related technical problems of endovascular stent aneurysms of internal carotid artery.To evaluate the value of stent assisted coil embolization in patients with multiple injuries.Methods:This study was a retrospective study.The subjects were small wide-necked aneurysms patients who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Zhejiang University from January 2012 to June 2017.Position,maximum diameter:2-3 mm,Effect of immediate postoperative embolization(Effect of immediate postoperative embolization)were measured and the clinical outcome of the patients was assessed by Glasgow prognostic score(GOS:glasgow outcome scale)after three months of embolization.Intraoperative and postoperative complications(Complication)were observed and recorded.Analysis and comparison:angiography was performed immediately after the operation to assess the effect of embolization:complete embolization(the coil could not be replanted,the angiography confirmed the aneurysm non Development),the subtotal embolism and the partial embolism.Three months after embolization,the clinical outcome was evaluated by Glasgow Outcome Scale(GOS)in Glasgow.Patients were followed up for 6 months,1 years,2 years,and 3 years after operation.The complications were divided into intraoperative(aneurysm rupture,thrombus formation,spring ring or stent displacement)and postoperative complications(after aneurysm ruptured and infarct).Results:24 patients were successfully implanted in the stent,including 3 Neuroform stents,2 Lvis stents,6 Enterprise stents and 13 Solitaire stents(Table 1).Of the 24 patients,18 were completely embolized(75%),5 were subtotal embolization(20.8%),and 1 were partially embolized(4.2%).In case 4,the head end of the micro catheter was squeezed out of the aneurysm neck when the first coils were embolized,and the subsequent embolism could only be abandoned,considering that the high risk of reset tube could only be partially embolized.Case 3.When the stent was completely released,the coil could not be embolized because of the displacement of the microcatheter.Figure 1?3 is an angiogram of a typical case before,during and after operation.Of the 24 patients,the clinical effect was good in 21 cases(GOS 4?5),disability in 2 cases(GOS 3),and death in 1 cases(GOS 1).1 cases(4.2%,1)had thrombolytic embolism immediately after placement of stent,with urokinase thrombolytic therapy,the patient had a good clinical effect;1 cases(4.2%,17)had basal ganglia infarction after operation,and the infarct scope narrowed after treatment;1 cases(4.2%,6)suffered a projectile after the stent was pressed tightly.The spring ring pierced the aneurysm wall and ruptured aneurysm.3 d after operation died of severe vasospasm.Conclusion:1.stent assisted coil embolization is feasible in the treatment of small wide necked internal carotid artery aneurysms.2.the key to successful placement of microcatheter is the use of endovascular and recyclable scaffolds.3.endovascular operation and reusable stent can effectively prevent the risk of aneurysm rupture.