原作出处：Ayad A, Yamac E, Chapot R. Balloon-assisted coiling followed by Half-T or Complete-T stenting of unruptured superior cerebellar artery aneurysms. AJNR Am J Neuroradiol. 2026 Jan 8:ajnr.A9157. doi: 10.3174/ajnr.A9157. Epub ahead of print. PMID: 41506845.

● 占颅内动脉瘤约2%

● 解剖挑战极大

  ✔ 血管管径细：80%患者SUCA直径仅1.0-1.5mm

  ✔ 起源部成角锐利

  ✔ 瘤颈常累及基底动脉（BA）/大脑后动脉（PCA）

  ✔ 毗邻脑干与关键穿支

● 既往治疗方案均存在局限

  ✔ 单纯栓塞复发率高

  ✔ 常规支架在锐角处贴壁不良

  ✔ 血流导向装置（FD）后循环缺血风险显著（文献报道8%-25%）

  ✔ 且既往多数研究将其与基底动脉其他动脉瘤合并分析，缺乏针对性治疗策略

1. 球囊辅助弹簧圈栓塞（BAC）

● 微导管塑形：Echelon 10蒸汽塑形为猪尾构型，便于SUCA超选

● 双腔球囊：Eclipse 2L或Scepter XC，实现致密填塞

● 水凝胶弹簧圈：二代Hydrocoils——低复发率的三大核心因素之一

● 关键操作：73%病例采用双侧入路+双球囊（SUCA球囊+对侧椎动脉入路PCA-BA球囊），应对复杂瘤颈

Figure 1. A, Steam-shaping of the Echelon 10 microcatheter into a pigtail configuration for vessel access. B, Final confirmation of the microcatheter tip after shaping. C, Sequential steps in selective access to the superior cerebellar artery (SUCA): introduction of the steam-shaped Echelon 10 microcatheter, advancement into the SUCA, balloon positioning following an exchange maneuver, and initiation of coil deployment.

2. 锥束CT排除出血

● 核心目的：确认无出血后再行支架置入，规避“支架后出血”的抗栓两难困境

● 万一术中出现破裂，可立即充盈球囊止血

3. 编织支架T型置入——两种构型

● Half-T——首选策略（40/55）

  ✔ 支架先部分远端释放，逐步调整位置，直到近端节段完全覆盖瘤颈，这是实现精准贴壁、优化瘤颈覆盖的核心步骤

  ✔ 解决SUCA-BA锐角贴壁问题

● Complete-T

  ✔ Half-T基础上，额外从PCA向BA释放第二枚支架，重建分叉

  ✔ 术中判断弹簧圈不稳定、瘤颈广泛累及BA/PCA

术中决策原则：构型选择实时决定，依据球囊辅助下弹簧圈稳定性及瘤颈覆盖效果；注意静态3D与术中动态球囊造影的瘤颈形态差异。

Figure 2. A, Repositioning of the braided stent to achieve optimal coverage of the aneurysm neck, with slight protrusion into the basilar artery. B, Unsubtracted and subtracted angiographic images demonstrating optimal neck coverage with the Half-T stenting technique. C, Example of a superior cerebellar artery (SUCA) aneurysm involving the origin of the posterior cerebral artery (PCA), showing good coverage of the aneurysm neck.

Figure 3. Giant superior cerebellar artery (SUCA) aneurysm treated with balloon-assisted coiling and Complete-T stenting. A, Initial digital subtraction angiography demonstrating a 28-mm aneurysm. B and C, Unsubtracted and subtracted angiographic images at 12-month follow-up confirming complete occlusion (Raymond Roy Class I). D, Axial post-contrast T1-weighted MR image before treatment. E and F, Axial pre- and post-contrast T1-weighted MR images at 12-month follow-up demonstrating stability without growth or wall enhancement.

所有患者术后72小时内常规行MRI检查，用于评估围手术期缺血并发症，12个月随访采用DSA+MRI联合评估。

唯一死亡病例：Complete-T组1例巨大动脉瘤（28mm）使用FRED FD，术后动脉瘤再通、脑干压迫，14个月死亡——提示FD在SUCA巨大动脉瘤中风险极高。