颅内动脉瘤破裂急性期LVIS支架辅助弹簧圈栓塞治疗分析  

LVIS stent-assisted coil embolization in the acute stage of ruptured intracranial aneurysms

作　　者：康俊龙[1] 田新华[1] 吴启锋 陈锷[1] 丰伟[1] 黄延林[1] 杨芳裕[1] 童俊江 刘忠 Kang Junlong;Tian Xinhua;Wu Qifeng;Chen E;Feng Wei;Huang Yanlin;Yang Fangyu;Tong Junjiang;Liu Zhong(Department of Neurosurgery,Zhongshan Hospital,Xiamen University,Xiamen 361000,Fujian,China;Xiamen Medical Emergency Center,Xiamen 361021,Fujian,China)

机构地区：[1]厦门大学附属中山医院神经外科,福建厦门361000 [2]厦门市医疗急救中心,福建厦门361021

出　　处：《中华危重病急救医学》2020年第7期828-834,共7页Chinese Critical Care Medicine

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2016YFC1300800);福建省厦门市重要重大疾病联合攻关项目(3502Z20179406)。

摘　　要：目的评估在颅内动脉瘤破裂急性期采用LVIS支架辅助弹簧圈栓塞治疗的安全性和有效性。方法回顾分析2016年1月至2018年12月厦门大学附属中山医院收治的55例颅内动脉瘤破裂急性期采用LVIS支架辅助弹簧圈栓塞治疗患者的临床资料。收集患者的一般资料、动脉瘤特征和围手术期并发症发生情况。记录患者出院时及随访6个月时的临床预后,格拉斯哥预后评分(GOS)5分为预后良好,3~4分为预后一般,1~2分为预后差;记录患者栓塞治疗后即刻和随访6个月时的脑血管造影结果,采用Raymond分级评估动脉瘤闭塞情况,Ⅰ级为完全闭塞,Ⅱ级为瘤颈残留,Ⅲ级为瘤体残留。结果55例患者均在动脉瘤破裂72 h内接受LVIS支架辅助弹簧圈栓塞治疗,所有支架均成功释放;其中男性16例(占29.1%),女性39例(占70.9%);中位年龄53(24~80)岁;前循环动脉瘤49例(89.1%),后循环动脉瘤6例(10.9%);Hunt-Hess动脉瘤分级Ⅰ~Ⅱ级43例(78.2%),Ⅲ级7例(12.7%),Ⅳ~Ⅴ级5例(9.1%)。55例患者栓塞治疗后首次数字减影血管造影(DSA)检查提示,有41例动脉瘤完全闭塞,14例瘤颈残留;动脉瘤越小者栓塞治疗后的完全闭塞率越高,完全闭塞组动脉瘤最大径≤7 mm患者比例明显高于瘤颈残留组(100.0%比64.3%,P<0.01)。55例患者中,有1例术中出现支架内血栓,1例术中出现斑块脱落引起的远端血管栓塞,1例术中出现血管痉挛,1例术后出现远隔部位脑出血;2例死亡患者中,1例死于心力衰竭,1例死于重症肺炎导致的呼吸衰竭。出院时预后良好40例,预后一般10例,预后差5例;入院时Hunt-Hess分级越低者的预后越好,预后良好组入院时Hunt-Hess分级为Ⅰ~Ⅱ级的患者比例明显高于预后一般组和预后差组(90.0%比50.0%、40.0%,P<0.01)。55例患者中有39例完成术后6个月临床预后和脑血管造影随访,GOS评分均≥3分,其中32例动脉瘤完全闭塞、4例瘤颈残留、3例瘤体残留;动脉瘤越小者6Objective To evaluate the safety and efficacy of LVIS stent-assisted coil embolization in the acute phase of ruptured intracranial aneurysms.Methods The clinical data of 55 patients with ruptured intracranial aneurysm treated with LVIS stent-assisted coil embolization admitted to Zhongshan Hospital of Xiamen University from January 2016 to December 2018 were analyzed retrospectively. The general data, the characteristics of aneurysms and the occurrence of perioperative complications of the patients were collected. The clinical prognosis of the patients at discharge and 6 months of follow-up was recorded. The Glasgow prognosis score (GOS) was graded as good (5), average (3-4), and poor (1-2), and the cerebral angiography results were recorded immediately after embolization and 6-month follow-up. The aneurysm occlusion was assessed by Raymond grade, Raymond Ⅰ was complete obliteration, Ⅱ was residual neck and Ⅲ was residual aneurysm.Results All 55 patients received LVIS stent-assisted coil embolization within 72 hours of ruptured intracranial aneurysms, and all stents were released successfully, including 16 males (29.1%) and 39 females (70.9%). The median age was 53 (24-80) years old. Anterior circulation aneurysms were found in 49 patients (89.1%) and posterior circulation aneurysms in 6 patients (10.9%). According to Hunt-Hess classification, there were 43 patients with grade Ⅰ-Ⅱ (78.2%), 7 patients with grade Ⅲ (12.7%) and 5 patients with grade Ⅳ-Ⅴ (9.1%). The first digital subtraction angiography (DSA) examination of 55 patients after embolization showed that 41 patients had complete obliteration of aneurysms and 14 had residual neck;and the smaller the aneurysm was, the higher the rate of complete obliteration after embolization was. The proportion of small aneurysms (maximum diameter ≤ 7 mm) in the complete obliteration group was significantly higher than that in the neck residual group (100.0% vs. 64.3%, P < 0.01). Among the 55 patients, there was 1 patient suffered from in-stent thrombosi

关 键 词：颅内动脉瘤破裂 蛛网膜下腔出血 支架辅助弹簧圈栓塞 LVIS支架 

分 类 号：R743.35[医药卫生—神经病学与精神病学]