对比性分析LVIS支架和Enterprise支架辅助弹簧圈栓塞颅内破裂宽颈动脉瘤的安全性和有效性  

Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms:comparison of LVIS stents with Enterprise stents

作　　者：刘钊[1] 陈鹏[1] 车彦军[1] 潘恩裕[1] 朱军 刘艳[2] LIU Zhao;CHEN Peng;CHE Yan-jun(Department of Neurosurgery,Jingjiang People's Hospital,Jingjiang 214500,China)

机构地区：[1]江苏省靖江市人民医院神经外科,靖江214500 [2]江苏省靖江市人民医院神经内科,靖江214500

出　　处：《临床神经外科杂志》2022年第6期693-698,共6页Journal of Clinical Neurosurgery

基　　金：泰州市第五期“311高层次人才培养工程”(RCPY202004);泰州市科技局项目(20200086)。

摘　　要：目的对比性分析LVIS支架辅助弹簧圈与Enterprise支架辅助弹簧圈治疗急性破裂宽颈颅内动脉瘤的安全性和有效性。方法回顾性分析2018年1月—2020年12月在靖江市人民医院接受LVIS支架辅助弹簧圈(LVIS支架组34例)和Enterprise支架辅助弹簧圈(Enterprise支架组50例)治疗的急性破裂宽颈颅内动脉瘤患者的临床资料。收集患者年龄、性别、动脉瘤位置、动脉瘤大小、颈部宽度、Hunt-Hess分级和改良Fisher分级等资料。对围手术期相关并发症及临床和血管造影随访结果进行比较,进行单变量和多变量分析以确定手术相关并发症和潜在危险因素之间的关系。结果血管造影结果显示,LVIS支架组的完全闭塞率高于Enterprise支架,复发率较低(88.2%vs 68%,P=0.039;8.3%vs 14.6%,P=0.360)。两组在出院和随访时的临床结果无显著差异(分别为P=0.212和P=0.817)。术中血栓形成、术后脑梗、术中出血和术后出血在LVIS支架组和Enterprise支架组的发生率分别是5.9%vs 6.0%,2.9%vs 0%,2.9%vs 6.0%和0%vs 2.0%。多因素分析显示糖尿病(OR=5.924,95%CI=1.152~30.481,P=0.033)和高级别Hunt-Hess分级(OR=9.450,95%CI=1.185~75.392,P=0.034)是影响围手术期并发症的独立因素。结论与Enterprise支架辅助弹簧圈栓塞颅内破裂宽颈动脉瘤相比,LVIS支架辅助栓塞有更高的即刻完全闭塞率,而两组的手术并发症率和长期复发率相似。多因素分析显示糖尿病和高级别Hunt-Hess分级是影响围手术期并发症的独立因素。Objective To compare the safety and efficacy of LVIS stent-assisted coiling with those of Enterprise stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.Methods The clinical data of patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling(LVIS stent group 34 cases)and Enterprise stent-assisted coiling(Enterprise stent group 50 cases)admitted to Jingjiang People's Hospital from January 2018 to December 2020 were analyzed retrospectively.The age,gender,aneurysm location,aneurysm size,neck width,Hunt-Hess grade,and modified Fisher grade were collected.Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared.Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.Results Angiographic results showed that the total occlusion rate of LVIS stent group was higher than that of Enterprise stent group,and the recurrence rate was lower(88.2%vs 68%,P=0.039,8.3%vs 14.6%,P=0.360).The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences(P=0.212 and P=0.817,respectively).The rates of intraprocedural thrombosis,postprocedural thrombosis,intraprocedural bleeding and postoperative early rebleeding in the LVIS stent group and Enterprise stent group were 5.9%vs 6.0%,2.9%vs 0%,2.9%vs 6.0%and 0%vs 2.0%,respectively.Multivariate analysis showed that a history of diabetes(OR=5.924,95%CI=1.152-30.481,P=0.033)and Hunt-HessⅢ-Ⅳgrade(OR=9.450,95%CI=1.185-75.392,P=0.034)were independent predictors for perioperative complications.Conclusions Compared with Enterprise stent assisted coil embolization for intracranial ruptured wide necked aneurysms,LVIS stent assisted embolization has a higher rate of immediate total occlusion,while the surgical complication rate and long-term recurrence rate of the two groups are similar.Multivariate analysis show that dia

关 键 词：LVIS支架 Enterprise支架 颅内破裂宽颈动脉瘤 手术并发症 

分 类 号：R651[医药卫生—外科学]