摘要目的:探讨LEO Baby支架辅助弹簧圈栓塞颅内宽颈动脉瘤的安全性和有效性。方法:回顾性分析2018年12月至2019年6月郑州大学人民医院脑血管病科收治的21例颅内宽颈动脉瘤患者的临床资料。21例患者共23个动脉瘤，其中5个位于前交通动脉，10个位于大脑中动脉分叉处，2个位于大脑中动脉M1段、3个位于M2段、3个位于大脑前动脉A3段；所有动脉瘤的颈体比均>1/2。其中，22个动脉瘤采用单纯LEO Baby支架辅助弹簧圈栓塞，另1个采用Y形支架(LEO Baby ＋ Neuroform EZ)栓塞。术后即刻行血管造影检查，以判断动脉瘤闭塞和支架内血流通畅情况。出院后对所有患者进行随访，术后3个月评估改良Rankin量表评分(mRS)，以判断患者预后，其中≤2分为预后良好；术后6～8个月复查数字减影血管造影(DSA)，以判断动脉瘤闭塞和支架内血流通畅情况。结果:21例患者的手术均成功，技术成功率为100%。术后即刻造影显示，18个(78.3%)动脉瘤为Raymond Ⅰ级，3个(13.0%)为Ⅱ级，2个(8.7%)为Ⅲ级。2例(9.5%，2/21)患者术后出现并发症，其中1例因重度肺部感染死亡；另1例因迟发性血管痉挛导致脑梗死，出院时mRS为3分。20例患者术后3个月均行mRS，其中1例为1分、1例为2分，余18例均为0分；预后均良好。16例患者的17个动脉瘤获得DSA随访，随访时间为(6.4±0.7)个月(6～8个月)，其中15个为术后即刻Raymond Ⅰ级，显示闭塞完全；另2个分别为术后即刻Raymond Ⅱ、Ⅲ级，均未见瘤颈、瘤腔进一步增长。所有动脉瘤均未出现支架内狭窄或迟发性血栓形成事件。结论:初步推测LEO Baby支架应用于具有小直径载瘤动脉的颅内宽颈动脉瘤栓塞中是安全、有效的；同时为颅内位于血管分叉部和血管远端的动脉瘤治疗提供一种新的选择。

abstractsObjective:To evaluate the safety and efficacy of LEO Baby stent-assisted coiling in the treatment of wide-neck intracranial aneurysms.Methods:Between December 2018 to June 2019, 21 patients with wide-neck intracranial aneurysms were treated with LEO Baby stent-assisted coiling at Department of Cerebrovascular Disease, Zhengzhou University People′s Hospital and retrospectively enrolled into this study. There were 23 aneurysms in those 21 patients. Among them, 5 aneurysms were located on the anterior communicating artery, 10 at the bifurcation of middle cerebral artery, 2 at the M1 segment of middle cerebral artery, 3 at the M2 segment of middle cerebral artery and 3 at the A3 segment of the anterior cerebral artery. The ratio of neck/dome was more than 1/2 in all intracranial aneurysms. Single LEO Baby stent-assisted coiling was used in 22 aneurysms, and the other aneurysms was treated with the Y stent technique (LEO Baby + Neuroform EZ). After the procedure, the immediate DSA was performed to evaluate the aneurysm occlusion and the parent artery patency. The clinical follow-up was performed in all patients for 3 months post discharge. The modified Rankin Scale (mRS) score was used to determine the patient′s outcome and the mRS ≤2 was defined as good outcome. After 6 to 8 months, DSA was performed to evaluate the aneurysm occlusion and stent patency.Results:A total of 21 patients with 23 aneurysms were all successfully treated. The immediate postprocedural Raymond scale of the aneurysms were assessed which indicated grade Ⅰ in 18 aneurysms (78.3%), Ⅱ in 3 (13.0%) and Ⅲ in 2 (8.7%). The periprocedural complications rate was 9.5% (2/21). Out of the 2 patients with complications, 1 died of severe pulmonary infection, and the other developed cerebral infarction due to the late-onset cerebral vasospasm and the mRS score was 3 at discharge. Twenty patients obtained 3-month clinical follow-up post procedure, and the mRS scores were 1 in 1 patient, 2 in 1 and 0 in the remaining 18. All patients had good outcomes (mRS≤2). Sixteen patients with 17 aneurysms obtained the imaging follow-up lasing for 6.4±0.7 months (range: 6-8 months) post procedure. Of those, 15 aneurysms were Raymond Ⅰ immediately post procedure indicating complete embolization, and the other 2 were Raymond Ⅱ and Ⅲ respectively immediately post surgery, none of which showed any further growth in the tumor neck and dome. No in-stent stenosis or delayed thromboembolic events were noted in 17 patients.Conclusions:This preliminary study has suggested that LEO Baby stent-assisted coiling seems safe and effective in the embolization of intracranial aneurysms on small-diameter arteries, which can be used as an option for treatment of aneurysms at intracranial bifurcation or far ends of arteries.