Pipeline血流导向装置治疗未破裂Willis环远端动脉动脉瘤  

Pipeline for unruptured aneurysms beyond the circle of Willis

作　　者：马超 燕鹏[1,2] 张宇鹏 梁飞 梁世凯[3] 姜除寒 Ma Chao;Yan Peng;Zhang Yupeng;Liang Fei;Liang Shikai;Jiang Chuhan(Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070、China;Department of Neurosurgery,Beijing Tsinghua Changgeng Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]首都医科大学附属北京天坛医院神经介入中心,100070 [2]首都医科大学,北京市神经外科研究所,100070 [3]清华大学附属北京清华长庚医院神经外科,102218

出　　处：《中华神经外科杂志》2019年第9期885-889,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81371314)。

摘　　要：目的探讨Pipeline血流导向装置(PED)治疗未破裂Willis环远端动脉动脉瘤的疗效和并发症。方法回顾性纳入2016年1月至2019年1月在首都医科大学附属北京天坛医院神经介入中心(11例)和清华大学附属北京清华长庚医院神经外科(3例)采用PED治疗的未破裂Willis环远端动脉动脉瘤患者,其中单纯置入PED 10例,联合弹簧圈4例。14例均为单发动脉瘤;11例为初次治疗,3例为复发性动脉瘤。术后采用改良Rankin量表评分(mRS)标准评估患者的预后;影像学随访采用O'kelly-Marotta(OKM)分级标准评估动脉瘤的栓塞情况<结果14例患者(14个动脉瘤)共置入17枚PED,手术均成功。2例患者术后出现脑梗死[1例为前交通动脉夹层动脉瘤.1例为大脑中动脉(MCA)Ml段夹层动脉瘤],经药物治疗后症状均改善;1例MCA Ml段夹层动脉瘤患者,术后9 h发生动脉瘤破裂,治疗后死亡。出院时神经功能良好(mRS为0~1分)者11例,伴有神经功能障碍(mRS为3分)者2例。术后随访12例,随访时间为3.0-6.0(4.7±1.4)个月。末次随访mRS 0分者11例,1分者1例;造影复查显示,12例患者的12个动脉瘤中,完全闭塞9个(OKM分级D级),瘤颈残余3个(OKM分级C级)。3例复发者术后6个月随访动脉瘤均为完全闭塞。结论PED治疗Willis环远端动脉动脉瘤大部分安全有效,治疗MCA动脉瘤的风险可能较高。对于复发的Willis环远端动脉动脉瘤再治疗效果好。Objective To investigate the efficacy and complications of Pipeline embolization device(PED)in the treatment of unruptured aneurysms beyond the circle of Willis.Methods A retrospective study was conducted on the clinical data of 14 patients with unruptured aneurysms beyond the circle of Willis treated with PED at De part me nt of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University(n=11)and Department of Neurosurgery,Beijing Tsinghua Changgung Hospital(n=3)from January 2016 to January 2019.Among those,10 cases underwent PED implantation and 4 underwent PEDassisted coiling.Each case among the 14 patients had a single aneurysm.Eleven cases underwent first treatment and 3 were recurrent cases.Modified Ranking scale(mRS)was used to comprehensively evaluate the patients after surgery.Patients were followed up radiographically at 6,12 and 24 months post surgery,and the O'kelly-Marotta(OKM)grading was used to evaluate aneurysm embolization.Results A total of 17 PEDs were implanted in 14 patients,all of which were successful.Immediate postoperative cerebral infarction was observed in 2 patients(1 case of A Co A dissecting aneuiysm and 1 case of MCA Ml dissecting aneurysm),and the symptoms were improved after medication.One patient with MCA Ml dissecting aneurysm ruptured at 9 h post surgery and died after treatment.At discharge,there were 11 patients with good postoperative neurological function(mRS:0-1)and 2 patientswith neurological dysfunction(mRS;3).There were 12 patients who obtained follow-up post operation with an average follow-up duration of 3.0-6.0(4.7±1.4)months.At last follow-up,the mRS scores were 0 in 11 cases and 1 in 1 case.Angiographic follow-up showed that 9 of the 12 aneurysms in the 12 patients were completely occluded and 3 had residual neck.All the 3 patients with recurrent aneurysms revealed complete embolization at 6-month follow-up post operation.Conclusions PED is generally safe and effective in the treatment of umuptured aneuiysms beyond the circle of Willis which

关 键 词：颅内动脉瘤 大脑动脉环 远端 Pipeline血流导向装置 

分 类 号：R74[医药卫生—神经病学与精神病学]