目的:评估多模式管理技术结合外科肌肉包裹的效果,裁剪,颈内动脉(ICA)血泡样动脉瘤(BBA)破裂患者的引流支架(FDS)放置。
方法:在2020年至2023年的回顾性病例系列回顾中,三名ICABBAs破裂患者接受了多模式管理,一种结合肌肉包裹的方法,手术夹钳,和FDS栓塞。动脉瘤囊最初用多个定制的颞肌移植物包装并包裹,然后使用开窗夹固定,具有良好的ICA分支保存。在剪切后2-3周放置FDS。
结果:所有三名患者均患有正确的ICABBAs(平均年龄,52年)。修改后的Hunt和Hess等级为2至3,Fisher等级为3至4。平均血管造影随访时间为27.7个月(15、31和37个月)。在随访计算机断层扫描期间,没有出现症状性血管痉挛或可见的缺血性中风。无患者需要脑脊液分流术植入,所有患者均获得了良好的神经系统转归(改良Rankin量表0-1)。随访数字减影血管造影未发现动脉瘤复发或明显的ICA狭窄。
结论:我们讨论了一种有前途的多模式管理方法,用于破裂的ICABBAs结合肌肉包裹,手术夹钳,和FDS栓塞。该技术安全有效地防止了再破裂,实现积极的短期临床结果。需要进一步的研究和更广泛的研究来验证这种方法的长期疗效。
背景:
OBJECTIVE: To evaluate the effects of a multimodal management technique combining surgical muscle wrapping, clipping, and flow-diverter stent (FDS) placement in patients with ruptured blood blister-like aneurysms (BBAs) in the internal carotid artery (ICA).
METHODS: In a retrospective
case series review from 2020 to 2023, three patients with ruptured ICA BBAs underwent multimodal management, an approach combining muscle wrapping, surgical clipping, and FDS embolization. The aneurysm sac was initially packed and wrapped with multiple tailored temporalis muscle grafts and then secured using fenestration clips, with good preservation of the ICA branches. The FDS was placed 2-3 weeks after the clipping.
RESULTS: All three patients had right ICA BBAs (mean age, 52 years). The modified Hunt and Hess grades ranged from 2 to 3, and the Fisher grades ranged from 3 to 4. The mean angiography follow-up time was 27.7 months (15, 31, and 37 months). There were no instances of symptomatic vasospasm or visible ischemic stroke during follow-up computed tomography. No patient required cerebrospinal fluid shunt implantation, and all achieved favorable neurological outcomes (modified Rankin Scale 0-1). Follow-up digital subtraction angiography revealed no evidence of aneurysm recurrence or significant ICA stenosis.
CONCLUSIONS: We discuss a promising multimodal management approach for ruptured ICA BBAs combining muscle wrapping, surgical clipping, and FDS embolization. This technique was safe and effective in preventing re-rupture, achieving positive short-term clinical outcomes. Further research and more extensive studies are required to validate the long-term efficacy of this approach.
BACKGROUND: