支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的临床分析  

Stent-assisted coil embolization for acutely ruptured wide-necked intracranial aneurysms

作　　者：曾文贤 李振均 张剑波 蒙宏亮 段传志[1] 李西锋[1] 张炘[1] 何旭英[1] Zeng Wenxian;Li Zhenjun;Zhang Jianbo;Meng Hongliang;Duan Chuanzhi;Li Xifeng;Zhang Xin;He Xuying(National Key Clinical Specialty, Engineering Technology Research Center of Ministry of Education, Guangdong Key Laboratory of Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China)

机构地区：[1]国家临床重点专科,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,南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2019年第3期243-249,共7页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81400943).

摘　　要：目的探讨支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的有效性及安全性。方法南方医科大学珠江医院神经外科自2011年1月至2018年5月应用支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤患者160例(共160个破裂动脉瘤)。回顾性分析患者的临床资料、疗效及并发症发生情况,比较有并发症和无并发症患者临床资料的差异。采用改良Rankin量表评分(mRS)评估患者预后,采用单因素及多因素Logistic回归分析明确影响患者预后的危险因素。结果160枚支架均释放成功。术后即刻数字减影血管造影(DSA)检查显示127个(79.4%)动脉瘤达到完全栓塞,17个(10.6%)动脉瘤瘤颈残留,16个(10.0%)动脉瘤瘤体残留。出现手术相关并发症17例(10.6%),其中出血相关并发症6例(3.8%),缺血相关并发症11例(6.9%)。有缺血相关并发症患者和无缺血相关并发症患者动脉瘤部位的分布差异有统计学意义(P<0.05);24例(15%)患者预后不良,136例(85%)患者预后良好。预后良好患者和预后不良患者入院mRS评分、术前Hunt-Hess分级、支架类型的分布差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示入院mRS评分≥4分、术前Hunt-Hess分级Ⅳ~Ⅴ级、Solitaire支架是患者预后不良的独立危险因素。结论支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤安全有效。入院时mRS评分≥4分、术前Hunt-Hess分级Ⅳ~Ⅴ级、使用Solitaire支架的患者易发生预后不良。Objective To explore the efficacy and safety of stent-assisted coil embolization of acutely ruptured wide-necked intracranial aneurysms. Methods One hundred and sixty patients with acutely ruptured wide-necked intracranial aneurysms (160 ruptured aneurysms), admitted to and underwent stent-assisted coil embolization in our hospital from January 201l to May 2018, were chosen. The clinical data, outcomes and complications of these patients were retrospectively analyzed. The differences of clinical data between patients with and without complications were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients. Univariate and multivariate Logistic regression analyses were conducted to analyze the risk factors of prognoses. Results All 160 stents were successfully released. Complete occlusion after endovascular procedures was achieved in 127 patients (79.4%);17 aneurysms (10.6%) had neck residual and 16 aneurysms (10.0%) had aneurysm residual. Surgery-related complications occurred in 17 patients (10.6%), of which, 6 (3.8%) showed hemorrhagic events and 11 (6.9%) had ischemic events. The distributions of aneurysm sites between patients with ischemia related complications and those without ischemia related complications were statistically different (P<0.05). Poor prognosis was noted in 24 patients (15%) and good prognosis was noted in 136 (85%). The mRS scores, preoperative Hunt-Hess grades and distributions of stent types between patients with good prognosis and patients with poor prognosis were statistically different (P< 0.05). Logistic regression analysis indicated that baseline mRS scores≥4 (OR=39.000, 95%CI: 10.861-140.038, P=0.000), preoperative Hunt-Hess grading IV-V (OR=13.000, 95%CI: 4.063-41.596, P=0.015), and Solitaire stents placement (OR=3.333, 95%CI: 1.332-8.339, P=0.028) were the independent risk factors for poor clinical outcomes in patients with acutely ruptured wide-necked intracranial aneurysms. Conclusion Stent-assisted coil embolization is suggested to be a sa

关 键 词：颅内动脉瘤 血管内治疗 支架 栓塞 破裂 

分 类 号：R651.12[医药卫生—外科学]