LVIS支架治疗后不完全栓塞颅内动脉瘤中期随访时治愈的影响因素分析  

Related risk factors for progressive occlusion of intracranial aneurysms treated with low-profile visualized intraluminal support device stent in mid-term follow up

作　　者：郇林春[1] 孙运帅 张浩[2] 于建军[1] 郭锋[1] 蔡菁 刘于海[1] 王诗良 Huan Linchun;Sun Yunshuai;Zhang Hao;Yu Jianjun;Guo Feng;Cai Jing;Liu Yuhai;Wang Shiliang(Department of Neurosurgery,Linyi People's Hospital of Shandong Province,Linyi 276000,China;Clinic School,Weifang Medical College of Shandong Province,Weifang 261000,China)

机构地区：[1]临沂市人民医院神经外科,276000 [2]潍坊医学院临床学院,潍坊261000

出　　处：《中华神经医学杂志》2019年第12期1229-1235,共7页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81571144)。

摘　　要：目的观察LVIS支架栓塞术后即刻未能达到完全栓塞的颅内动脉瘤患者随访期间的动脉瘤的影像学变化,分析影响动脉瘤治愈的危险因素。方法选择临沂市人民医院神经外科自2014年12月至2018年12月应用LVIS支架栓塞术治疗的颅内动脉瘤患者161例(总计193个动脉瘤),患者术后即刻行DSA检查,根据Raymond分级标准评估动脉瘤的栓塞程度。对比患者术后8个月随访时及术后即刻动脉瘤的栓塞程度,统计动脉瘤的治愈(Raymond分级1级)情况。采用单因素Logistic回归分析及多因素Logistic回归分析(向前最大似然比法)筛选影响不完全栓塞动脉瘤治愈的危险因素。结果术后即刻动脉瘤的栓塞程度为Raymond分级1级78个、2级54个、3级61个,动脉瘤完全栓塞78个(40.41%)、动脉瘤不完全栓塞115个(59.59%)。随访结果显示193个动脉瘤中Raymond分级1级171个、2级10个、3级12个,动脉瘤完全栓塞171个(88.60%),动脉瘤不完全栓塞22个(11.40%)。术后即刻不完全栓塞的115个动脉瘤中随访时治愈94个,治愈率为81.74%(94/115)。单因素Logistic回归分析发现高血压、糖尿病、后循环动脉瘤、夹层动脉瘤、体颈比及术后即刻栓塞程度是动脉瘤治愈的危险因素(P<0.05);多因素Logistic回归分析发现后循环动脉瘤(OR=7.551,95%CI:2.354~24.222)、糖尿病(OR=5.562,95%CI:1.446~21.393)为动脉瘤治愈的独立危险因素(P<0.05)。其回归模型的受试者工作特征曲线(ROC)的曲线下面积(AUC)为0.755,说明回归模型的预测效能中等。结论LVIS支架栓塞术治疗颅内动脉瘤效果显著,即使术后即刻不完全栓塞的患者在中期随访时也具有较高的治愈率。动脉瘤位于后循环及合并糖尿病会影响动脉瘤的治愈。Objective To analyze the angiographic results of intracranial aneurysms without complete embolization immediately after low-profile visualized intraluminal support device(LVIS)stent at mid-term follow up,and explore the risk factors for healing of partial occluded aneurysms.Methods One hundred and sixty-one patients with intracranial aneurysms treated by LVIS stent embolization in our hospital from December 2014 to December 2018 were selected;193 aneurysms in total,including 93 un-ruptured aneurysms and 100 ruptured aneurysms,were noted.DSA was performed immediately after operation to evaluate the degrees of aneurysm embolization according to Raymond grading criteria.The embolization degrees of aneurysms were compared at 8 months after surgery and immediately after surgery,and the healing of aneurysms(Raymond grading 1)was calculated.Univariate Logistic regression analysis and multivariate Logistic regression analysis(forward maximum likelihood ratio method)were used to screen the risk factors for healing of incomplete aneurysm embolization.Results The embolization degrees immediately after surgery were as follows:78 were with Raymond grading 1,54 with Raymond grading 2,and 61 with Raymond grading 3;complete aneurysm embolization were noted in 78 aneurysms(40.41%)and incomplete aneurysm embolization were noted in 115(59.59%).Follow up(8 months after surgery)results indicated that,of the 193 aneurysms,171 were with Raymond grading 1,10 with Raymond grading 2,and 12 with Raymond grading 3;there were 171 aneurysms(88.60%)having complete aneurysm embolization and 22(11.40%)having incomplete aneurysm embolization.In the aneurysms having incomplete aneurysm embolization immediately after surgery,the healing rate was 81.74%(94/115).Univariate Logistic regression analysis showed that hypertension,diabetes mellitus,posterior circulation aneurysm,dissecting aneurysm,body-neck ratio and embolization degrees immediately after surgery were risk factors for healing of aneurysms(P<0.05).Multivariate Logistic regression analysis

关 键 词：颅内动脉瘤 血管内治疗 LVIS支架 栓塞 

分 类 号：R651[医药卫生—外科学]