脑动脉瘤颈部直径对支架辅助弹簧圈栓塞术后进行性脑血管闭塞发生的预测价值  

Predictive value of cerebral aneurysm neck diameter on the occurrence of progressive cerebrovascular occlusion after stent-assisted coil embolization

作　　者：马肃[1] 李涵[1] Ma Su;Li Han(Department of Neurosurgery,Yulin First Hospital,Suide,Shanxi 718000,China)

机构地区：[1]榆林市第一医院神经外科,陕西省绥德市718000

出　　处：《中国脑血管病杂志》2019年第5期237-242,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨脑动脉瘤经支架辅助弹簧圈栓塞术治疗后不完全性闭塞出现进行性脑血管闭塞的预测因素。方法回顾性连续纳入于2012年1月至2015年12月在榆林市第一医院神经外科接受支架辅助弹簧圈栓塞术并经术中即刻血管造影提示为不完全性闭塞的92例脑动脉瘤患者,并依据术后6个月全脑血管造影随访结果,分为进行性闭塞组(59例)与未闭塞组(33例)。利用双平面造影系统和三维旋转造影系统采集患者术后即刻和术后6个月的多维度血管造影图像,并通过Raymond分级标准对所有患者的血管造影结果进行分级评估。采用多因素Logistics回归分析、受试者工作特征(ROC)曲线评估进行性脑血管闭塞的预测因素。结果进行性闭塞组患者脑动脉瘤平均最大直径[(6.6±2.9) mm]和平均颈部直径[(4.9±1.0) mm]均小于未闭塞组患者[分别为(8.5±2.4)、(6.2±1.2) mm],差异均有统计学意义(t值分别为-3.196、-5.561,均P <0.01)。多因素Logistic回归分析结果表明,脑动脉瘤的颈部直径是进行性脑血管闭塞的独立影响因素(OR=0.44,95%CI:0.18～0.79,P=0.030); ROC曲线分析结果表明,颈部直径预测进行性脑血管闭塞的截断值为5.8 mm(特异度为82.1%,敏感度为75.8%),曲线下面积为0.847 (P <0.01)。结论脑动脉瘤颈部直径是支架辅助弹簧圈栓塞术后出现进行性脑血管闭塞的独立因素,颈部直径<5.8 mm的脑动脉瘤患者在支架辅助弹簧圈栓塞术治疗后6个月内更易自发性出现进行性脑血管闭塞。Objective To investigate the predictive factors of developing progressive cerebrovascular occlusion in incomplete occlusion after cerebral aneurysms treated with stent-assisted coil embolization. Methods Ninety-two consecutive patients with cerebral aneurysm received stent-assisted coil embolization and immediate intraoperative angiography revealed incomplete occlusion at the Department of Neurosurgery,Yulin First Hospital from January 2012 to December 2015 were enrolled retrospectively.According to the follow-up results of angiography 6 months after operation,the patients were divided into progressive occlusion group ( n =59) and non-occlusion group ( n =33).Multi-dimensional angiographic images of patients immediately and 6 months after surgery were collected using a biplane angiography system and a three- dimensional rotational angiography system,and the angiographic results of all patients were graded by the Raymond grading criteria.Predictors of progressive cerebrovascular occlusion were assessed using multivariate logistic regression analysis and receiver operating characteristic (ROC) curves. Results The mean maximum diameter of cerebral aneurysms (6.6±2.9 mm) and mean neck diameter (4.9±1.0 mm) in the progressive occlusion group were less than those in the non-occlusion group (8.5±2.4 mm and 6.2± 1.2 mm respectively).The differences were statistically significant.( t =-3.196 and -5.661 respectively,all P < 0.01).Multivariate logistic regression analysis showed that the neck diameter of cerebral aneurysms was an independent influencing factor for progressive cerebrovascular occlusion ( OR,0.44,95% CI 0.18 - 0.79, P = 0.030).The cut-off value of neck diameter for predicting cerebrovascular occlusion was 5.8 mm ( specificity 82.1%,sensitivity 75.8%,and the area under curve 0.847, P <0.01). Conclusions The neck diameter of cerebral aneurysms was an independent predictor for progressive cerebrovascular occlusion after stent-assisted coil embolization.Patients with cerebral aneurysms <5.8 mm in neck diamete

关 键 词：脑动脉瘤 脑动脉瘤颈部直径 支架辅助弹簧圈栓塞术 进行性脑血管闭塞 

分 类 号：R651.12[医药卫生—外科学]