Tubridge血流导向装置治疗大型和巨大型颈内动脉海绵窦段动脉瘤的长期疗效  

Tubridge flow diverter for the treatment of large and giant cavernous carotid aneurysms： a long-term follow-up study

作　　者：周宇[1] 杨鹏飞[1] 李强[1] 杨新健[2] 姜除寒[2] 赵瑞[1] 黄清海[1] 洪波[1] 许奕[1] 刘建民[1] 

机构地区：[1]第二军医大学附属长海医院神经外科脑血管病中心,上海200433 [2]首都医科大学北京市神经外科研究所首都医科大学附属北京天坛医院神经介入科

出　　处：《中华神经外科杂志》2017年第8期760-764,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81400979,81571126）

摘　　要：目的 评价Tubridge血流导向装置（FD）在大型和巨大型颈内动脉海绵窦段动脉瘤治疗中的安全性和有效性.方法 前瞻性连续纳入第二军医大学附属长海医院临床神经医学中心神经外科2010年11月至2014年12月收治的27例颈内动脉海绵窦段大型和巨大型动脉瘤患者,其中16例患者的16个动脉瘤采用Tubridge FD结合弹簧圈栓塞治疗,11例患者的11个动脉瘤采取单纯TubridgeFD治疗,据此将患者分为FD＋弹簧圈置入组和单纯FD置入组.术后行门诊或者电话随访,记录患者的临床症状改善情况及行影像学检查.结果 本组27例患者的27个动脉瘤共置入38枚Tubridge FD,均成功输送并释放,技术成功率100％.26例患者行临床症状随访,随访时间为7～76个月,平均（49.8±15.4）个月;其中15例患者临床症状消失,5例症状改善,6例症状无变化,临床症状的缓解率为77％ （20/26）,无缺血性或出血性并发症发生.单纯FD置入和FD＋弹簧圈置入两组患者临床症状改善情况的差异无统计学意义（P=0.29）.25例患者行数字减影血管造影或磁共振血管成像随访,随访时间为6 ～48个月,平均（22.8±13.1）个月;其中20个动脉瘤（20/25,80％）完全闭塞,4个动脉瘤（4/25,16％）进一步血栓形成,1个动脉瘤（1/25,4％）为无症状性载瘤动脉闭塞;支架覆盖的分支均保持通畅.结论 TubridgeFD治疗大型和巨大型颈内动脉海绵窦段动脉瘤患者的长期疗效满意,占位效应缓解率高.Objective To evaluate the safety and efficacy of Tubridge blood flow diverter （FD） in the treatment of large and giant cavernous carotid aneurysms.Methods The clinical and angiographic data of 27 patients harboring 27 large or giant cavernous carotid aneurysms and treated between November 2010 and December 2014 at Department of Neurosurgery,Clinical Neuroscience Center,Changhai Hospital,Second Military Medical University,were prospectively collected and analyzed.Among them,16 aneurysms were treated with Tubridge FD combined with coil embolization,while the other 11 were treated with merely Tubridge FDs.Tubridge FDs were employed in all those cases,which were postoperatively followed up in clinics or by telephone to document the patients＆#39;symptomatic improvement and imaging results.Results A total of 38 Tubridge FDs were successfully implanted for the 27 aneurysms.During the follow-up lasting from 27 to 76 months （mean：49.8 ± 15.4 months）,clinical symptoms were resolved in 15 out of 26 patients,improved in 5,and unchanged in 6.In total,the rate of symptomatic relief was 77% （20/26）.Procedurerelated morbidity and mortality were both 0.Follow-up angiographies,with a mean follow-up period of 22.8 ± 13.1 （6-48 months）,were available in 25 aneurysms.Complete occlusion was observed in 20/25 （80%） aneurysms,further thrombosis was reported in 4/25 （16%） cases,and non-symptomatic parent artery occlusion was reported in （1/25,4%）.All stent-associated branches were patent.Conclusion It is suggested that Tubridge FD is a safe and effective tool for treatment of large and giant cavernous carotid aneurysms with high resolving rate of compression symptoms.

关 键 词：颅内动脉瘤 栓塞 治疗性 颈内动脉海绵窦段 血流导向装置 长期疗效 

分 类 号：R651.12[医药卫生—外科学]