血流导向装置治疗颅内未破裂串联动脉瘤的疗效分析  

Efficacy analysis of flow diverters in the treatment of unruptured tandem intracranial aneurysms

作　　者：徐善才[1] 孙博文[1] 吴培[1] 孟钰骁 王春雷[1] 季智勇[1] 徐超[1] 吴桥伟 史怀璋[1] Xu Shancai;Sun Bowen;Wu Pei;Meng Yuxiao;Wang Chunlei;Ji Zhiyong;Xu Chao;Wu Qiaowei;Shi Huaizhang(Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,哈尔滨150001

出　　处：《中华神经外科杂志》2022年第8期800-804,共5页Chinese Journal of Neurosurgery

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2021-04-61)。

摘　　要：目的:探讨血流导向装置(FD)治疗颅内未破裂串联动脉瘤的临床疗效。方法:回顾性分析2018年4月至2020年10月哈尔滨医科大学附属第一医院神经外科采用FD治疗的19例颅内未破裂串联动脉瘤患者的临床资料。19例患者中,3例为双侧串联,16例为单侧串联,共计47个未破裂动脉瘤。所有动脉瘤均应用FD治疗。术后应用改良Rankin量表评分(mRS)评估预后,术后6个月以上行数字减影血管造影(DSA)随访,根据O′Kelly-Marotta(OKM)分级评估动脉瘤的闭塞情况。应用单因素logistic回归分析探究影响随访时动脉瘤OKM分级D级闭塞的相关因素。结果:47个动脉瘤共置入22枚FD(Pipeline 14枚,Tubridge 8枚),均顺利到位并释放;其中3个辅助填入弹簧圈。术后1例患者出现短暂性脑缺血发作,经对症治疗后改善。19例患者临床随访的中位时间为29个月(11~41个月)。至末次随访,mRS均为0分。17例患者(40个动脉瘤)接受DSA随访,中位随访时间为10个月(3~19个月);其中OKM分级A级3个(7.5%),B级3个(7.5%),C级2个(5.0%),D级32个(80.0%)。单因素logistic回归分析结果显示,动脉瘤瘤颈宽度、最大径、体颈比、动脉瘤位于载瘤动脉腹侧或背侧、是否联合弹簧圈栓塞、血流导向装置类型均非影响动脉瘤达到OKM分级D级闭塞的因素(均P>0.05)。结论:应用FD治疗颅内未破裂串联动脉瘤的闭塞率较高,并发症较少,较为安全、有效。Objective To investigate the efficacy of flow diverters(FD)in the treatment of unruptured tandem intracranial aneurysms.Methods The clinical data of 19 patients with unruptured tandem intracranial aneurysms treated with FD from April 2018 to October 2020 in the Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed.Of the 19 patients,3 had bilateral tandem intracranial aneurysms and 16 had unilateral tandem intracranial aneurysms,and there were a total of 47 unruptured aneurysms.All aneurysms were treated with FD.The modified Rankin scale score(mRS)was used to evaluate the outcome after operation.Follow-up with digital subtraction angiography(DSA)was performed more than 6 months after operation,and the occlusion of aneurysm was evaluated according to O′Kelly-Marotta(OKM)classification.Univariate logistic regression analysis was used to explore the related factors of aneurysm OKM grade D occlusion during follow-up.Results A total of 22 FDs(14 Pipeline devices and 8 Tubridge devices)were implanted in 47 aneurysms,all of which were successfully placed in place and released;3 of them were filled with coils.Transient ischemic attack occurred in 1 patient after operation,which improved after symptomatic conservative treatment.The median time of clinical follow-up in 19 patients was 29 months(11-41 months).At the last follow-up,the mRS of all patients was 0.Seventeen patients(40 aneurysms)were followed up by DSA,and the median follow-up time was 10 months(3-19 months).Among them,there were 3 cases(7.5%)of OKM grade A,3 cases(7.5%)of grade B,2 cases(5.0%)of grade C,and 32 cases(80.0%)of grade D.The results of univariate logistic analysis showed that aneurysm neck width,maximum diameter,dome-to-neck ratio,aneurysm location on the ventral or dorsal side of the parent artery,whether coil embolization was used or not,or the type of FD did not affect aneurysm occlusion(all P>0.05).Conclusion Application of FD in the treatment of unruptured tandem intracranial aneu

关 键 词：颅内动脉瘤 血管内操作 治疗结果 串联动脉瘤 血流导向装置 

分 类 号：R651.12[医药卫生—外科学]