大型/巨大型颅内动脉瘤支架辅助与单纯弹簧圈栓塞术后复发率比较  

Stent-assisted coil embolization versus simple coil embolization for large and giant intracranial aneurysms: comparison of postoperative recurrence rate

作　　者：柯勋昌 何旭英[1] 李西锋[1] 张炘[1] 方钦锐 李维[1] 王泽群[1] 刘文超[1] 段传志[1] KE Xunchang HE Xuying LI Xifeng ZHANG Xin FANG Qinrui LI Wei WANG Zequn LIU Wenchao DUAN Chuanzhi(Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, the Engineering Technology Research Center of Education Ministry of China, the National Key Clinical Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, Guangdong Province 510282, China)

机构地区：[1]南方医科大学珠江医院神经外科,教育部工程技术研究中心,广东省脑功能修复与再生重点实验室,广州510282

出　　处：《介入放射学杂志》2017年第7期579-584,共6页Journal of Interventional Radiology

基　　金：国家重点研发计划项目(2016YFC1300800);广东省科技计划项目(2016A020215098);南方医科大学临床研究启动计划项目(LC2016ZD024)

摘　　要：目的比较单纯弹簧圈栓塞和支架辅助弹簧圈栓塞颅内大型/巨大型动脉瘤的复发率及远期血管造影随访结果。方法回顾性分析2004年1月至2016年1月收治的90例(91枚)大型或巨大型(>10 mm)颅内动脉瘤患者临床及影像资料,其中接受单纯弹簧圈栓塞治疗(NAC组)52例(52枚),支架辅助弹簧圈栓塞治疗(SAC组)38例(39枚),统计分析两组间术后动脉瘤复发率差异及复发危险因素。结果术后动脉瘤复发率、再治疗率分别为38.5%(35/91)、20.9%(19/91),其中SAC组分别为35.9%(14/39)与17.9%(7/39),NAC组分别为40.4%(21/52)与23.1%(12/52),但两组间差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,破裂动脉瘤(OR=0.284,95%CI=0.083~0.978,P=0.046)、单纯弹簧圈栓塞(OR=5.03,95%CI=1.04~24.44,P=0.045)、伴有高血压(OR=0.13,95%CI=0.036~0.51,P=0.003)及远期随访(OR=1.002,95%CI=1.001~1.003,P=0.002)是大型/巨大型动脉瘤复发的危险因素。结论支架辅助弹簧圈栓塞可降低颅内大型/巨大型动脉瘤复发率,动脉瘤破裂、单纯弹簧圈栓塞、远期随访及伴发高血压是动脉瘤栓塞术后复发的独立危险因素。Objective To compare the recurrence rate and long-term follow-up angiographic findings between stent-assisted coil embolization and simple coil embolization in treating large and giant intracranial aneurysms. Methods The clinical data and imaging materials of a total of 90 patients with large and giant i ntracranial aneurysms （〉10 mm, 91 aneurysms in total）, who were admitted to authors＇ hospital during the period from January 2004 to January 2016 to receive interventional embolization therapy, were retrospectively analyzed. Of the 90 patients, 52 patients （52 lesions in total） received simple coil embolization （SCE group） and 38 patients （39 lesions in total） received stent-assisted coil embolization （SACE group）. Postoperative recurrence rates of aneurysm were compared between the two groups, and recurrence risk factors were analyzed. Results The whole postoperative recurrence rate of aneurysm and re-treatment rate were 38.5% （35/91） and 20.9%（19/91） respectively; the recurrence rate and re-treatment rate of SACE group were 35.9% （14/39） and 17.9% （7/39） respectively, while those of SCE group were 40.4% （21/52） and 23.1% （12/52） respectively; the differences between the two groups were not statistically significant （P〉0.05）. Multivariate logistic regression indicated that the recurrence risk factors of large or giant intracranial aneurysms included rupture of aneurysm （OR=0.284, 95%CI=0.083-0.978, P=0.046）, simple coil embolization （OR= 5.03, 95%CI=1.04-24.44, P=0.045）, concurrent hypertension （OR=0.13, 95%CI=0.036-0.51, P=0.003） and long time after operation （OR=1.002, 95%CI=1.001-1.003, P=0.002）. Condttsion Compared with simple coil embolization, stent-assisted coil embolization can reduce the recurrence rate of aneurysm. Rupture of aneurysm, simple coil embolization, long time after operation and concurrent hypertension are independent risk factors for recurrence of aneurysm after transcatheter arterial embolization.

关 键 词：大型/巨大型动脉瘤 血管内栓塞 支架 复发 远期随访 

分 类 号：R651.12[医药卫生—外科学]