血流导向装置治疗复杂颅内动脉瘤单中心经验  

Flow diverters in treatment of complex intracranial aneurysms:a single-center experience

作　　者：吕楠[1] 周宇[1] 杨鹏飞[1] 方亦斌[1] 李强[1] 赵瑞[1] 赵开军[1] 许奕[1] 洪波[1] 黄清海[1] 刘建民[1] Lü Nan;ZHOU Yu;YANG Peng-fei;FANG Yi-bin;LI Qiang;ZHAO Rui;ZHAO Kai-jun;XU Yi;HONG Bo;HUANG Qing-hai;LIU Jian-min(Department of Neurosurgery,Changhai Hospital,Naval Medical University (Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院神经外科,上海200433

出　　处：《第二军医大学学报》2019年第3期304-310,共7页Academic Journal of Second Military Medical University

基　　金："十三五"国家重点研发计划(2016YFC1300700);国家自然科学基金(81571118;81701775)~~

摘　　要：目的评价应用Tubridge和Pipeline血流导向装置治疗复杂颅内动脉瘤的安全性和有效性。方法回顾性连续纳入我科2010年8月至2017年12月应用血流导向装置治疗的99例患者共101个复杂颅内动脉瘤的临床资料,其中91个为首次治疗,10个为复发动脉瘤。动脉瘤平均最大径为(19.6±6.6)mm,94个位于前循环,7个位于后循环。61例患者的61个动脉瘤应用Tubridge血流导向装置治疗,38例患者的40个动脉瘤应用Pipeline血流导向装置治疗。术后予以临床随访与影像学随访。结果 99例患者的101个动脉瘤共置入血流导向装置116枚(Tubridge74枚、Pipeline 42枚),均成功输送并释放。术后1例患者发生迟发性出血并死亡,2例发生缺血性并发症。88个动脉瘤获得了影像学随访,其中短期随访(0～6个月)完全闭塞率为66.7%(42/63)、中长期随访(7～18个月)完全闭塞率为73.5%(36/49)、长期随访(>18个月)完全闭塞率为89.3%(25/28)。全部动脉瘤末次影像学随访完全闭塞率为72.7%(64/88),Tubridge组和Pipeline组分别为73.6%(39/53)和71.4%(25/35),差异无统计学意义(P>0.05)。结论应用Tubridge血流导向装置与Pipeline血流导向装置治疗复杂颅内动脉瘤均安全有效,但也存在一定的并发症风险。Objective To evaluate the safety and efficacy of Tubridge and Pipeline embolization devices in the treatment of complex intracranial aneurysms. Methods The clinical data of 99 patients harboring 101 complex intracranial aneurysms, who underwent embolization device treatment between Aug. 2010 and Dec. 2017 in our department, were retrospectively collected and analyzed. Among them, 91 aneurysms were treated for the first time and 10 were recurrent lesions. The mean maximum diameter of the aneurysms was (19.6±6.6) mm. Ninety-four lesions were located in anterior circulation and 7 in posterior circulation. Sixty-one aneurysms of 61 patients were treated with Tubridge embolization device, and 40 of 38 patients were treated with Pipeline embolization device. Clinical and angiographic follow-up were preformed conventionally. Results A total of 116 embolization devices (74 Tubridge and 42 Pipeline) were delivered and implanted successfully. One patient died of delayed hemorrhage, and 2 patients suffered from ischemic events after operation. Angiographic follow-up data was available in 88 aneurysms. The complete occlusion rates of short-term (0-6 months), mid-term (7-18 months) and longterm (>18 months) were 66.7%(42/63), 73.5%(36/49) and 89.3%(25/28), respectively. The complete occlusion rate of all aneurysms was 72.7%(64/88) at the last imaging follow-up, and there was no significant difference between the Tubridge and Pipeline groups (73.6%[39/53] vs 71.4%[25/35], P>0.05). Conclusion Both Tubridge and Pipeline embolization devices are safe and effective in treatment of complex intracranial aneurysms. However, the complications shall not be ignored after implantation of embolization device.

关 键 词：颅内动脉瘤 血流导向装置 安全性 有效性 

分 类 号：R651.22[医药卫生—外科学]