Surpass Streamline血流导向装置治疗颅内动脉瘤的初步分析  

Preliminary application of Surpass Streamline blood flow diverting device in the treatment of intracranial aneurysms

作　　者：罗斌[1,2] 刘健 张义森[1] 刘爱华[1] 穆士卿[1] 李佑祥[1] 杨新健[1] 吕明[1] Luo Bin;Liu Jian;Zhang Yisen;Liu Aihua;Mu Shiqing;Li Youxiang;Yang Xinjian;Lyu Ming(Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]首都医科大学附属北京天坛医院神经介入中心,北京100070 [2]北京大学国际医院神经外科,北京102206

出　　处：《中华神经外科杂志》2022年第2期159-164,共6页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨Surpass Streamline血流导向装置(FD)治疗颅内动脉瘤的有效性和安全性。方法回顾性分析2020年11月至2021年3月首都医科大学附属北京天坛医院神经介入中心采用Surpass Streamline FD治疗46例颅内动脉瘤患者的临床资料。46例患者共57个动脉瘤,其中动脉瘤位于颈内动脉眼动脉段28个、交通段8个、海绵窦段19个和颈段1个,椎动脉V4段1个。采用O′Kelly-Marotta(OKM)分级评估术后即刻及随访时动脉瘤的栓塞程度;采用改良Rankin量表评分(mRS)评价患者围手术期及随访时的神经功能;术后6个月开始采用数字减影血管造影(DSA)或CT血管成像(CTA)复查动脉瘤的闭塞情况。结果57个颅内动脉瘤共置入46枚FD,其中一次性释放成功42枚(91.3%);另4枚FD未能一次性释放成功,但经过桥接、套叠和球囊扩张后均达到满意的释放效果。单纯置入FD 43例,FD结合弹簧圈治疗3例。57个动脉瘤术后即刻DSA显示动脉瘤内对比剂明显滞留,OKM分级A级30个,B级19个,C级5个,D级3个。术后43例(93.5%)患者的预后良好(mRS≤2分);其余3例(6.5%)患者出现不同程度的缺血性并发症。共32例患者(37个动脉瘤)行DSA或CTA随访,随访时间为(6.6±1.8)个月(3~10个月),动脉瘤完全闭塞32个(86.5%)(OKM分级均为D级)。32例患者末次随访时未出现新发缺血或出血性并发症,mRS≤2分。结论Surpass Streamline FD治疗颅内动脉瘤的即刻疗效满意,中期随访动脉瘤闭塞率较高且并发症的发生率较低,但长期疗效及安全性有待于进一步观察。Objective To preliminarily evaluate the efficacy and safety of Surpass Streamline flow diverting device(FD)in the treatment of intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of 46 patients with intracranial aneurysms treated with Surpass Streamline FD at the Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University from November 2020 to March 2021.There were 57 aneurysms in 46 patients.Among them,there were 28 ophthalmic segment aneurysms,8 communicating segment aneurysms,19 cavernous sinus segment aneurysms,1 carotid segment aneurysm and 1 vertebral V4 segment aneurysm.The O′Kelly-Marotta(OKM)grading scale was used to assess the degree of embolization of aneurysms immediately after surgery and during follow-up.The modified Rankin scale(mRS)was used to evaluate the neurological function of patients during the perioperative period and during follow-up.At 6 months after surgery,digital subtraction angiography(DSA)or CT angiography(CTA)was performed to review the occlusion of the aneurysm.Results A total of 46 FDs were implanted in 57 intracranial aneurysms in 46 patients.Among them,42 FDs(91.3%)were successfully released at one time;the other 4 FDs were not successfully released at one time,but after bridging,overlapping and balloon dilation,satisfactory release effects were achieved.Forty-three patients were treated with FD implantation alone,and three patients were treated with FD combined with coiling.The DSA of 57 aneurysms immediately after the operation showed that the contrast agent was well filled in the aneurysm,and the OKM grades were grade A in 30 cases,grade B in 19,grade C in 5,and grade D in 3.After the operation,43 patients(93.5%)had a good outcome(mRS≤2 points);the remaining 3 patients(6.5%)had various degrees of ischemic complications.A total of 32 patients(37 aneurysms)underwent DSA or CTA follow-up,the follow-up time was 6.6±1.8 months(3-10 months),and 32 aneurysms(86.5%)were completely occluded(OKM grade D in

关 键 词：颅内动脉瘤 血管内手术 治疗结果 血流导向装置 

分 类 号：R651.12[医药卫生—外科学]