支架辅助栓塞治疗小型颅内宽颈动脉瘤的安全性及有效性  

Safety of stent-assisted embolization for small intracranial wide-necked aneurysms and its efficacy

作　　者：卢万俊[1] 韩长鸣 高峰 竺峰 LU Wanjun;HAN Changming;GAO Feng;ZHU Feng(Department of Neurology,Yangzhou Jiangdu People′s Hospital in Jiangsu Province,Yangzhou,Jiangsu,225200)

机构地区：[1]江苏省扬州市江都人民医院神经内科,江苏扬州225200

出　　处：《实用临床医药杂志》2021年第22期82-86,共5页Journal of Clinical Medicine in Practice

摘　　要：目的分析破裂与未破裂小型颅内宽颈动脉瘤支架辅助栓塞血管内治疗的安全性及临床效果。方法回顾性纳入30例小型颅内宽颈动脉瘤患者的临床资料,分为破裂组11例,未破裂组19例。所有患者均行支架辅助栓塞血管内治疗。分析手术并发症发生情况,采用Raymond分级评估手术效果,采用改良Rankin量表(mRS)评估预后。结果破裂组吸烟率高于未破裂组,差异有统计学意义(P<0.05);不同支架(LIVS、Enterprise和Solitaire-AB)术后即刻栓塞分级,LIVS支架辅助栓塞效果最佳,而Solitaire-AB支架辅助栓塞效果最差,差异有统计学意义(P<0.05)。与未破裂组比较,破裂组脑血管痉挛率增高,住院时间延长,出院时预后不良率增高,差异有统计学意义(P<0.05)。10例患者行影像随访复查,结果均为Raymond-Ⅰ级。结论支架辅助栓塞治疗小型颅内宽颈动脉瘤安全有效,特别在未破裂患者中,其即刻栓塞效果好、手术并发症少及随访结果良好,且LIVS支架可能更有优势。Objective To analyze the safety of stent assisted endovascular embolization for ruptured and unruptured small intracranial wide necked aneurysms and its clinical effect. Methods Clinical data of 30 patients with small intracranial wide neck aneurysm was retrospectively included, and they were divided into rupture group(11 cases) and unrupture group(19 cases). All patients were treated with stent-assisted endovascular embolization. The incidence of surgical complications was analyzed, the efficacy of operation was evaluated by Raymond grading, and the prognosis was evaluated by modified Rankin scale(mRS). Results The smoking rate in the ruptured group was significantly higher than that in unruptured group(P<0.05). The immediate postoperative embolization grading of different stents(LIVS, Enterprise and Solitaire-AB) showed that LIVS stent assisted embolization had the best effect, while Solitaire-AB stent assisted embolization had the worst effect(P<0.05). Compared with the unruptured group, the rate of cerebral vasospasm in the ruptured group was significantly higher, the length of hospitalization was significantly longer, and the rate of poor prognosis at discharge was significantly higher(P<0.05). Ten patients underwent imaging follow-up, and all of them were Raymond-Ⅰ grade. Conclusion Stent-assisted embolization for small intracranial wide-necked aneurysms is safe and effective, especially in unruptured patients. The therapy has good immediate embolization effect, fewer surgical complications and good follow-up results, and LIVS stents may have more advantages.

关 键 词：血管内操作 支架 栓塞 颅内动脉瘤 宽颈动脉瘤 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R61[医药卫生—临床医学]