探讨低剖面支架在未破裂大脑前动脉远端动脉瘤辅助栓塞中的安全性及有效性。

回顾性分析2018年1月至2023年12月南京医科大学第一附属医院采用低剖面支架辅助栓塞的大脑前远端未破裂动脉瘤患者29例（29个动脉瘤）的临床资料。其中大脑前动脉A2段动脉瘤15例，A3段动脉瘤14例。术后采用Raymond-Roy（R-R）分级标准判断动脉瘤的闭塞程度，采用改良Rankin量表（modified Rankin Scale，mRS）评估临床预后。

29例患者（29个动脉瘤）共置入29枚支架，支架置入成功率为100%。术后即刻动脉瘤闭塞R-R分级Ⅰ级17例（58.6%）、Ⅱ级11例（37.9%）、Ⅲ级1例（3.5%）。围手术期中3例（10.7%）患者发生缺血性并发症，经溶栓或替罗非班治疗后血栓溶解，其中仅有1例患者术后右侧肌力3级，复查头颅MR提示额叶小范围脑梗死，出院前患者症状有所好转，术后6个月随访右侧肌力4级。所有患者无出血性并发症发生。术后6个月，22例患者接受数字减影脑血管造影复查，其中R-R分级Ⅰ级20例（90.9%）、Ⅱ级1例（4.5%）、Ⅲ级1例（4.5%），R-R分级Ⅲ级的患者接受二次介入治疗。所有患者的mRS评分均≤2分。

采用低剖面支架辅助治疗大脑前动脉远端未破裂动脉瘤是一种安全有效的治疗方式，编织支架的远期闭塞率更佳，但存在一定的致栓性。

To explore the safety and efficacy of small-sized stents in the treatment of unruptured distal anterior cerebral aneurysms.

A retrospective analysis was conducted on 29 patients with 29 aneurysms who were admitted to our center and treated with low-profile stents from January 2018 to December 2023. Among them, 15 aneurysms were located in the A2 segment and 14 aneurysms were located in the A3 segment. After the procedure, the Raymond-Roy grading standard was used to judge the degree of occlusion of the aneurysm, and the modified Rankin scale (mRS) was used to evaluate the clinical prognosis.

A total of 29 stents were placed in 29 patients (29 aneurysms), and the success rate of stent placement was 100%. The immediate postoperative aneurysm occlusion results indicated class Ⅰ in 17 cases (58.6%), class Ⅱ in 11 cases (37.9%), and class Ⅲ in 1 case (3.5%) based on R-R classification. Among 29 patients, 3 patients (10.3%) had complications during the perioperative period, all of which were ischemic complications. After thrombolysis or tirofiban treatment, the thrombus dissolved, of which only one patient had postoperative right-sided muscle strength grade 3, review of cranial MR suggested a small frontal lobe cerebral infarction, and the patient's symptoms improved before discharge, and right-sided muscle strength was grade 4 at 6-month postoperative follow-up. There were no hemorrhagic complications in any of the patients. A total of 22 patients underwent digital subtraction angiography (DSA) examination, which indicated class Ⅰ in 20 cases (90.9%), class Ⅱ in 1 case (4.5%), class Ⅲ in 1 case (4.5%), and 1 patient had aneurysm recurrence. At 6 months postoperatively, 29 patients had mRS score ≤ 2.

For treatment of unruptured distal anterior cerebral aneurysms, small-sized stents-assisted embolization is safe and effective. Braided stents tend to have better long-term embolization but can lead to intraoperative thrombosis.