支架辅助栓塞治疗椎基底夹层动脉瘤复发的危险因素分析  

Predictors of recurrence of intracranial vertebrobasilar dissecting aneurysms after stent-assisted coiling

作　　者：李辉[1] 段传志[1] 李西锋[1] 何旭英[1] 张炘[1] 朱国辉[1] 方钦锐 王泽群[1] 

机构地区：[1]南方医科大学珠江医院神经外科、广东神经外科研究所、广东省脑功能修复与再生重点实验室,广州510282

出　　处：《中华神经医学杂志》2015年第6期567-571,共5页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金（81271315）;广东省科技计划项目（20128031800131）;国家临床重点建设专科资助项目：广东省神经外科临床中心资助项目

摘　　要：目的 探讨支架辅助栓塞治疗椎基底夹层动脉瘤的疗效及影响其复发的危险因素.方法 南方医科大学珠江医院神经外科自2005年1月至2014年1月行支架辅助栓塞治疗椎基底夹层动脉瘤68例,其中行双支架或三重支架辅助弹簧圈治疗27例,行单一支架结合弹簧圈治疗41例.回顾性分析患者的临床资料和疗效,多因素Logistic回归分析动脉瘤复发的危险因素. 结果 所有患者均未出现器械相关并发症,术后即刻部分栓塞31例,完全栓塞37例;预后良好60例,预后不良8例;复发8例,未复发60例.与未复发组比较,复发组患者的动脉瘤累及小脑后下动脉、采用单一支架辅助弹簧圈治疗、部分栓塞的比例较高,差异均有统计学意义（P＜0.05）;多因素Logistic回归分析显示动脉瘤累及小脑后下动脉、术后动脉瘤即刻栓塞程度是影响椎基底夹层动脉瘤介入治疗后复发的独立危险因素（P=0.015,P=0.022）. 结论 多重支架辅助弹簧圈栓塞动脉瘤可以降低动脉瘤的复发率.累及小脑后下动脉、术后部分栓塞的椎基底夹层动脉瘤较易复发.Objective To explore the effect of stent-assisted coiling on intracranial vertebrobasilar dissecting aneurysms and their risk factors of recurrence.Methods Sixty-eight consecutive patients with vertebrobasilar dissecting aneurysms,admitted to our hospital from January 2005 to January 2014 and underwent stent-assisted coiling,were chosen in our study;27 of them accepted double or treble stent-assisted coiling and 41 of them accepted single stent-assisted coiling;their clinical data were retrospectively reviewed.Follow-up outcomes were evaluated using modified Rankin Scale and risk factors of recurrence were analyzed by multivariable Logistic regression analysis.Results No instrument-related complications were noted;partial embolization was noted in 31 patients and total embolization was noted in 37 patients;60 enjoyed good prognosis and 8 enjoyed bad prognosis;there were 8 recurrences,2 had rebleeding and 6 had no rebleeding.Recurrence patients had significantly higher rate of posterior inferior cerebellar artery involvement,using single stent-assisted coiling and partial embolization （P〈0.05）.Multivariate Logistic regression analysis showed that involving the posterior inferior cerebellar artery and immediate obliteration grades were the independent risk factors for recurrence （P=0.015 and P=0.022）.Conclusions As compared with single stent,multiple overlapping stents with coils may enhance the immediate obliteration grades and decrease the recurrence rate.The immediate obliteration grades and involving the posterior inferior cerebellar artery are the independent risk factors for recurrence after reconstructive treatment of intracranial vertebrobasilar dissecting aneurysms.

关 键 词：椎基底夹层动脉瘤 即刻动脉瘤栓塞程度 再出血 复发 

分 类 号：R743[医药卫生—神经病学与精神病学]