Neuroform Atlas支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的疗效分析

doi:10.3877/cma.j.issn.2095-123X.2026.02.005

目的

评估Neuroform Atlas支架在颅内宽颈动脉瘤（WNIAs）介入治疗中的临床效果。

方法

回顾性分析2022年10月至2024年10月于四川省医学科学院·四川省人民医院神经外科接受Neuroform Atlas支架辅助干预的27例WNIAs患者的临床资料。术后即刻行DSA并采用Raymond-Roy分级表评估动脉瘤术后即刻闭塞状况，记录围术期各类相关并发症的发生情况。采用改良Rankin量表(mRS)评估患者的临床预后，并于术后12个月对患者完成影像学随访，评估动脉瘤的闭塞状况及并发症发生情况。

结果

27例患者均顺利完成支架植入操作，手术成功率为100%。术后即刻行全脑DSA显示，25例（92.59%）动脉瘤完全闭塞（Raymond-Roy Ⅰ级），2例（7.41%）患者存在瘤颈残余（Raymond-Roy Ⅱ级）。2例（7.41%）患者出现围术期并发症：1例（3.70%）为术中破裂动脉瘤再破裂，1例（3.70%）为术后颅内出血。出院时，24例（88.89%）患者神经功能恢复良好(mRS评分0~2分)，3例（11.11%）患者呈现出中度神经功能障碍（mRS评分3~5分）。出院3个月后，mRS评分：0分24例（88.89%），1分1例（3.70%），2分2例（7.41%）。术后12个月，所有患者均完成影像学随访，其中Raymond-Roy Ⅰ级24例（88.89%）、Ⅱ级3例（11.11%），且未出现与支架相关的并发症。

结论

Neuroform Atlas支架辅助栓塞技术治疗WNIAs具有较高的手术成功率和安全性。

关键词: 宽颈动脉瘤, Neuroform Atlas支架, 支架辅助栓塞术, 安全性, 疗效

Objective

To evaluate the clinical efficacy of the Neuroform Atlas stent in the endovascular treatment of wide-neck intracranial aneurysms (WNIAs).

Methods

A retrospective analysis was conducted on the clinical data of 27 patients with WNIAs who underwent Neuroform Atlas stent-assisted intervention in the Neurosurgery Department of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from October 2022 to October 2024. Postoperative DSA was performed immediately, and the Raymond-Roy classification was used to assess aneurysm occlusion status. Perioperative complications were recorded. Clinical outcomes were evaluated using the modified Rankin scale (mRS). Imaging follow-up was performed at 12 months after surgery to assess the aneurysm occlusion status and the incidence of complications.

Results

All 27 patients successfully underwent stent implantation, with a technical success rate of 100%. Immediate postoperative DSA showed complete occlusion (Raymond-Roy grade Ⅰ) in 25 cases (92.59%) and residual neck (grade Ⅱ) in 2 cases (7.41%). Perioperative complications occurred in 2 patients (7.41%): 1 case (3.70%) of intraoperative aneurysm rerupture and 1 case (3.70%) of postoperative intracranial hemorrhage. Upon discharge, 24 patients (88.89%) showed good neurological function recovery (mRS score 0-2), while 3 patients (11.11%) presented moderate neurological dysfunction (mRS score 3-5). At 3 months after discharge, mRS scores were 0 in 24 patients (88.89%), 1 in 1 patient (3.70%), and 2 in 2 patients (7.41%). At 12 months postoperatively, all patients completed imaging follow-up, showing Raymond-Roy grade Ⅰ in 24 cases (88.89%) and grade Ⅱ in 3 cases (11.11%), with no stent-related complications observed.

Conclusions

Neuroform Atlas stent-assisted embolization for WNIAs demonstrates a high procedural success rate and favorable safety profile.

Key words: Wide-neck aneurysms, Neuroform Atlas stent, Stent-assisted coiling, Safety, Efficacy

表1 27例颅内宽颈动脉瘤患者的一般资料

Tab.1 General information of 27 patients with wide-neck intracranial aneurysms

临床指标	数值
年龄（岁，mean±SD）	61.59±11.86
性别[例(%)]
男	10（37.04）
女	17（62.96）
动脉瘤破裂[例（%）]	6（22.22）
动脉瘤类型[例（%）]
小型动脉瘤	12（44.44）
中型动脉瘤	13（48.15）
大型动脉瘤	2（7.41）
动脉瘤位置[例（%）]
前交通动脉	11（40.74）
后交通动脉	2（7.41）
大脑中动脉	7（25.93）
大脑前动脉	3（11.11）
颈内动脉	3（11.11）
椎基底动脉	1（3.70）
动脉瘤特征
动脉瘤直径（mm，mean±SD）	6.21±2.83
瘤颈宽度[mm，M（P₂₅，P₇₅）]	4.43（2.70，5.00）
颈体比[M（P₂₅，P₇₅）]	0.70（0.57，0.81）
出院时mRS评分[例（%）]
0~2分	24（88.89）
>2分	3（11.11）

表1 27例颅内宽颈动脉瘤患者的一般资料

Tab.1 General information of 27 patients with wide-neck intracranial aneurysms

临床指标	数值
年龄（岁，mean±SD）	61.59±11.86
性别[例(%)]
男	10（37.04）
女	17（62.96）
动脉瘤破裂[例（%）]	6（22.22）
动脉瘤类型[例（%）]
小型动脉瘤	12（44.44）
中型动脉瘤	13（48.15）
大型动脉瘤	2（7.41）
动脉瘤位置[例（%）]
前交通动脉	11（40.74）
后交通动脉	2（7.41）
大脑中动脉	7（25.93）
大脑前动脉	3（11.11）
颈内动脉	3（11.11）
椎基底动脉	1（3.70）
动脉瘤特征
动脉瘤直径（mm，mean±SD）	6.21±2.83
瘤颈宽度[mm，M（P₂₅，P₇₅）]	4.43（2.70，5.00）
颈体比[M（P₂₅，P₇₅）]	0.70（0.57，0.81）
出院时mRS评分[例（%）]
0~2分	24（88.89）
>2分	3（11.11）

图1 颅内宽颈动脉瘤患者行Neuroform Atlas支架介入治疗前后的影像学资料A：术前3D造影显示：瘤颈为7.75 mm，瘤高为3.54 mm，瘤宽为6.23 mm；B：术前DSA示动脉瘤与载瘤动脉的关系；C：Neuroform Atlas 4.0 mm×24 mm支架辅助下完成栓塞治疗（支架两端分别释放于右侧大脑中动脉上干和下干）；D：术后DSA示动脉瘤完全闭塞（Raymond-Roy分级I级）；E~F：术后6个月复查全脑DSA示动脉瘤无残留及复发（Raymond-Roy分级I级），且载瘤动脉血流通畅

Fig.1 Imaging data of a patient with an intracranial wide-necked aneurysm before and after interventional treatment with a Neuroform Atlas stent

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Analysis of clinical outcomes of Neuroform Atlas stent-assisted coil embolization in the treatment of wide-neck intracranial aneurysms

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Analysis of clinical outcomes of Neuroform Atlas stent-assisted coil embolization in the treatment of wide-neck intracranial aneurysms