血管内栓塞颅内微小动脉瘤的临床疗效分析:单中心前瞻性研究  

Clinical effect analysis of endovascular embolization for the intracranial microaneurysm:a single-center prospective study

作　　者：肖志朋 崔雨迪 潘耀华[1] 万杰清[1] 张晓华[1] 赵兵[1] Xiao Zhipeng;Cui Yudi;Pan Yaohua;Wan Jieqing;Zhang Xiaohua;Zhao Bing(Department of Neurosurgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《中国脑血管病杂志》2021年第1期25-29,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81971093)。

摘　　要：目的前瞻性观察血管内栓塞颅内微小动脉瘤的安全性和有效性。方法连续纳入2016年12月至2019年7月于上海交通大学附属仁济医院行血管内治疗的48例患者共50个微小动脉瘤进行数据分析,瘤体最大直径≤3.0 mm定义为微小动脉瘤。破裂微小动脉瘤常规急诊行动脉瘤血管内栓塞;未破裂颅内微小动脉瘤常规完善术前检查,评估动脉瘤形态及其位置,选择血管内栓塞,优先考虑单纯弹簧圈栓塞。研究主要观察术后围术期并发症发生率、动脉瘤复发率和预后良好率。动脉瘤栓塞即刻评估采用Raymond-Roy分级(R-R分级);临床预后评估采用改良Rankin量表(mRS),mRS评分0~2分定义为预后良好。结果所有动脉瘤成功治疗,其中单纯弹簧圈栓塞术治疗19个动脉瘤,包括破裂动脉瘤8个、未破裂动脉瘤11个;采用支架辅助弹簧圈栓塞治疗31个动脉瘤,包括破裂动脉瘤7个(22.6%)、未破裂动脉瘤24个(77.4%)。破裂动脉瘤与未破裂动脉瘤治疗方式差异无统计学意义(χ2=2.138,P=0.143)。术中操作相关性动脉瘤破裂出血1例(2.1%),术后发生迟发性脑梗死1例(2.1%),动脉瘤无关远隔部位出血1例(2.1%)。动脉瘤完全致密栓塞(R-R分级Ⅰ级)41个(41/50,82.0%);术后6个月随访46例患者的48个动脉瘤,完全致密栓塞(R-R分级Ⅰ级)43个(43/48,89.6%),未见动脉瘤复发;总体预后良好(mRS评分0~2分)率为95.6%(44/46)。未破裂动脉瘤与破裂动脉瘤患者术后即刻及随访时栓塞程度及预后差异均无统计学意义(均P>0.05)。结论血管内栓塞对于破裂和未破裂微小动脉瘤的治疗安全可行。Objective To prospectively observe the safety and effectiveness of intravascular embolization of intracranial microaneurysms.Methods From December 2016 to July 2019,a total of 48 consecutive patients with 50 intracranial microaneurysms(≤3 mm)receiving endovascular treatment in the Department of Neurosurgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine were recruited.Emergency endovascular embolization was performed routinely for ruptured microaneurysms.Routine preoperative examination of unruptured microaneurysms was performed to evaluate the shape and location of aneurysms.Endovascular embolization approach was selected with priority to simple coil embolization.The study mainly observes the incidence of perioperative complications,the recurrence rate of aneurysms,and the rate of good prognosis.Immediate evaluation of aneurysm embolism was performed using Raymond-Roy(R-R)classification.The clinical prognosis was evaluated by the modified Rankin scale(mRS),and mRS score of 0-2 was defined as good prognosis.Results All aneurysms were successfully treated,among which 19 aneurysms were treated by coil embolization alone,including 8 ruptured aneurysms and 11 unruptured aneurysms.Stent-assisted coil embolization was performed in 31 aneurysms,including 7 ruptured aneurysms(22.6%)and 24 unruptured aneurysms(77.4%).There was no significant difference in the treatment modalities between ruptured aneurysm and unruptured aneurysm(χ2=2.138,P=0.143).Intraoperative procedure-related aneurysm rupture and bleeding occurred in 1 case(2.1%),postoperative cerebral infarction in 1 case(2.1%),and aneurysm-unrelated distant bleeding in 1 case(2.1%);complete dense embolization(R-R gradeⅠ)was achieved in 41 cases(41/50,82.0%).Forty-eight aneurysms of 46 patients were followed up for 6 months after surgery,and 43 cases(43/48,89.6%)achieved complete embolization(R-R gradeⅠ)without recurrence;overall good prognosis(mRS 0-2)rate was 95.6%(44/46).There were no statistically significant differences in embolization deg

关 键 词：微小动脉瘤 介入栓塞 出血 

分 类 号：R743[医药卫生—神经病学与精神病学]