LVIS支架辅助弹簧圈栓塞治疗后循环夹层动脉瘤的效果分析  

Effect analysis of LVIS stent assisted coil embolization in the treatment of posterior circulation dissecting aneurysms

作　　者：吕超 谢非 李侠 龙乾发[2] Lyu Chao;Xie Fei;Li Xia;Long Qianfa(Department of Neurosurgery,First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院神经外科,西安710032 [2]西安市中心医院神经外科,710003

出　　处：《中国脑血管病杂志》2020年第10期576-581,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析LVIS支架辅助弹簧圈栓塞治疗后循环夹层动脉瘤的效果和安全性。方法回顾性连续纳入2014年1月至2018年1月空军军医大学第一附属医院46例使用支架辅助弹簧圈栓塞治疗的后循环夹层动脉瘤患者的病历资料,按治疗方式,将46例患者分为LVIS支架组(LS组,19例)和非LVIS支架组(NLS组,27例),比较两组临床资料、手术结果和随访结果,包括围术期并发症、术后即刻栓塞效果(Raymond分级Ⅰ级为完全栓塞,Ⅱ~Ⅲ级为不完全栓塞)、术后神经功能恢复情况[改良Ramkin量表(mRS)评分0~2分为预后良好]、影像学随访动脉瘤治疗结果。结果(1)LS组19例患者均使用单支架治疗;NLS组17例患者使用单支架治疗,10例患者使用双支架治疗。两组患者性别、年龄、动脉瘤最大直径、是否破裂、部位、术前mRS评分的差异均无统计学意义(均P>0.05)。(2)LS组和NLS组术后即刻完全栓塞占比分别为11/19、15/27,围术期并发症发生占比分别为1/19、3/27,组间差异均无统计学意义(均P>0.05)。术后3个月随访结果,44例患者完成了DSA影像学随访,2例失访。DSA影像随访,LS组和NLS组完全闭塞占比分别为17/19、16/25,差异无统计学意义(P=0.114)。LS组和NLS组单支架治疗后动脉瘤完全闭塞占比分别为17/19、9/17,组间差异有统计学意义(P=0.025)。术后6~12个月随访时,32例患者完成了中期DSA随访,包括LS组15例、NLS组17例,14例失访。术后3个月随访神经功能恢复情况、6~12个月动脉瘤影像随访结果以及支架内狭窄发生占比的组间差异均无统计学意义(均P>0.05)。结论LVIS支架辅助弹簧圈栓塞治疗后循环夹层动脉瘤安全、有效,有助于提高术后3个月DSA影像随访时动脉瘤完全闭塞率。Objective To analysis the effect and safety of low-profile visualized intraluminal support(LVIS)stent assisted coil embolization in the treatment of dissecting aneurysms located in posterior circulation.Methods From January 2014 to January 2018,a total of 46 consecutive patients with posterior circulation dissecting aneurysms treated by stent assisted coil embolization who were admitted to the Department of Neurosurgery,the First Affiliated Hospital of Air Force Medical University,were retrospectively reviewed.Patients were divided into LVIS stent group(LS group,19 cases)and non-LVIS stent group(NLS group,27 cases)according to treatment modality.Clinical data,operation outcomes and follow-up results were compared between the two groups,including perioperative complications,postoperative immediate embolization effect(Raymond gradeⅠwas complete embolism,and gradeⅡ-Ⅲwas incomplete embolism),postoperative neurological function recovery[the modified Rankin scale(mRS)score of 0-2 was considered as good prognosis],and imaging follow-up results.Results(1)All the 19 patients in LS group were treated with single stent;in NLS group,17 patients were treated with single stent,and 10 patients were treated with double-stent intussusception.There was no significant difference in gender,age,aneurysm diameter,rupture,location and preoperative mRS score between the two groups(all P>0.05).(2)The proportion of immediate complete occlusion in LS group and NLS group was 11/19 and 15/27,respectively;the incidence of perioperative complications was 1/19 and 3/27,respectively.There were no significant differences in the immediate complete occlusion rate and perioperative complications rate between the two groups(P>0.05).DSA imaging follow-up was completed in 44 patients,and 2 patients were lost to follow-up.According to the DSA imaging results,the proportion of complete occlusion in LS group and NLS group was 17/19 and 16/25,respectively,and no statistical difference was found(P=0.114).While comparing cases treated by single stent,t

关 键 词：LVIS支架 后循环 动脉瘤 夹层 栓塞 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]