血流导向装置Pipeline联合弹簧圈在治疗颈内动脉大型和巨大型未破裂动脉瘤中的作用  

Roles of Pipeline embolization device in combination with coils in the treatment of large and giant unruptured internal carotid artery aneurysms

作　　者：李静伟[1] 李桂林[1] 陈圣攀 叶明[1] 何川[1] 张鸿祺[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2018年第1期4-9,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究(2016YFC1301804)

摘　　要：目的探讨血流导向装置Pipeline(PED)联合弹簧圈栓塞治疗颈内动脉大型和巨大型动脉瘤中的作用。方法回顾性分析首都医科大学宣武医院2014年1月至2016年12月使用PED治疗的颈内动脉大型(瘤径为10 mm^25 mm)和巨大型动脉瘤(瘤径>25 mm)患者51例(均为未破裂动脉瘤),其中男16例,女35例,年龄为15~71岁,平均(53±13)岁。根据是否使用弹簧圈填塞瘤腔,分为PED组31例和PED联合弹簧圈组20例,分析两组患者的治疗情况和≥6个月的影像随访效果。栓塞率以Raymond分级评价。结果对PED组31例患者32个动脉瘤[平均瘤径(15±3)mm]共使用33枚PED,其中海绵窦段动脉瘤15个,床突上段动脉瘤17个;PED联合弹簧圈组20例患者21个动脉瘤[平均瘤径(17±4)mm]共使用22枚PED,其中海绵窦段动脉瘤10个,床突上段动脉瘤11个。术后≥6个月影像学随访示PED组的动脉瘤复发率(Raymond分级Ⅱ~Ⅲ级)明显高于PED联合弹簧圈组[分别为9.7%(3例)和0%],PED联合弹簧圈组的血栓形成事件发生率明显高于PED组[分别为10.0%(2例)和6.5%(2例)],两组差异有统计学意义(P<0.05)。结论使用PED治疗颈内动脉大型和巨大型动脉瘤时,联合弹簧圈填塞瘤腔可降低动脉瘤残留发生率,但可能具有较高的血栓形成事件发生风险。仍需大样本量的前瞻性随机对照研究证实。Objective To investigate the roles of Pipeline embolization device（ PED） in combination with coils in the treatment of large and giant unruptured internal carotid artery aneurysms. Methods From January 2014 to December 2016,51 patients with large（ diameter 10-25 mm） and giant（ diameter 25 mm） internal carotid artery aneurysms treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively. Among them,35 were females and 16 were males,the average age was 53 ± 13 years（ range 15-71）. They were divided into a PED group（ n = 31） and a PED combined with coil group（ n = 20） according to whether using coils for packing aneurysm cavity or not. The treatment of two groups of patients and ≥6 months of imaging follow-up effect were analyzed. The embolic rate was evaluated by Raymond grade. Results Thirty-one patients with 32 aneurysms（ mean diameter 15 ± 3 mm） in the PED group were treated with 33 PEDs,including 15 with cavernous sinus aneurysm and 17 with supraclinoid aneurysm; 20 patients with 21 aneurysms（ mean diameter 17 ± 4 mm） were treated with 22 PEDs in the PED combined with coil group,including 10 cavernous sinus aneurysms and 11 supraclinoid carotid aneurysms. Six months after procedure,imaging follow-up revealed that the incidence of residual aneurysm（ Raymond grade Ⅱ-Ⅲ） in the PED group was significantly higher that that in the PED combined with coil group（ 9. 7% [n = 3] and 0%,respectively）. The incidence of thrombosis in PED combined with coil group was significantly higher than that in the PED group,there was significant difference between two groups（ P 0. 05）. Conclusions When using PED to treat large and giant internal carotid artery aneurysms,packing aneurysm cavity in combination with coils can reduce the incidence of residual aneurysm,but it may have a higher risk of thrombotic events. A prospective randomized controlled trial of large samples is still needed to prove it.

关 键 词：大型颈内动脉瘤 Pipeline栓塞装置 血流导向支架 弹簧圈 

分 类 号：R651.12[医药卫生—外科学]