Leo支架治疗颅内动脉瘤的多中心疗效分析  

Efficacy of Leo stents in the treatment of intracranial aneurysms:a multicentric study

作　　者：徐斌斌[1] 陈立军[1] 曹浪 彭亲清 张法永 秦宣锋 安庆祝 陈功 Xu Binbin;Chen Lijun;Cao Lang;Peng Qinqing;Zhang Fayong;Qin Xuanfeng;An Qingzhu;Chen Gong(Department of Neurosurgery,Putuo District People's Hospital,Shanghai 200060,China;Department of Neurosurgery,the Third People's Hospital of Jingdezhen,Jingdezhen 333000,China;Department of Neurosurgery,HuashanHospital,FudanUniversity,Shanghai 200040,China)

机构地区：[1]上海市普陀区人民医院神经外科,上海200060 [2]景德镇市第三人民医院神经外科,景德镇333000 [3]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华神经外科杂志》2022年第12期1209-1214,共6页Chinese Journal of Neurosurgery

基　　金：上海市科委医学引导类支撑项目(18411962400);国家自然科学基金(82071313);复旦大学上海医学院"医学名医培育工程"项目(DGF828007/028)

摘　　要：目的探讨Leo支架在颅内动脉瘤血管内治疗中的有效性和安全性。方法回顾性分析2019年8月至2021年8月多中心采用Leo支架治疗的152例颅内动脉瘤患者(共174个动脉瘤)的临床资料。其中上海市普陀区人民医院神经外科收治35例, 景德镇市第三人民医院神经外科收治13例, 复旦大学附属华山医院神经外科收治104例。术后行影像学和临床随访, 采用Raymond分级评估动脉瘤的栓塞程度, 以改良Rankin量表评分(mRS)评估患者的预后(mRS≤2分为预后良好, ≥3分为预后不良)。结果 174个动脉瘤中, 106个动脉瘤(60.9%)采用Leo支架+弹簧圈治疗, 68个动脉瘤(39.1%)单独应用Leo支架治疗。152例患者共采用176枚支架, 术中出现支架打开或贴壁不良9例(5.9%), 发生血栓栓塞事件15例(9.9%)。术后出现缺血症状7例(4.6%), 其中预后不良5例(3.3%)。无支架相关出血事件。术后即刻小型和中型动脉瘤的优良栓塞率(Raymond分级Ⅰ~Ⅱ级)分别93.8%(60/64)和90.5%(76/84), 明显优于大型及以上动脉瘤(42.3%, 11/26)(χ^(2)=41.77, P<0.001)。78例(51.3%)患者(共82个动脉瘤)获得随访, 随访时间为(11.8±6.5)个月(3~23个月)。各型动脉瘤的栓塞率保持稳定;发生载瘤动脉的支架内狭窄或闭塞共10例(12.8%, 10/78), 其中9例无症状。78例患者中, 预后良好76例(97.4%), 预后不良2例(2.6%)。结论采用Leo支架治疗颅内动脉瘤安全、有效, 特别是对于中、小型动脉瘤;而Leo支架在其他类型动脉瘤中的作用仍需进一步验证。Objective To investigate the efficacy and safety of Leo stents in the endovascular treatment(EVT)of intracranial aneurysms.NMethodsThe clinical data of 152 cases with 174 intracranial aneurysms treated by Leo stents were retrospectively analyzed from August 2019 to August 2021.Among them,35 patients were treated at the Department of Neurosurgery,Putuo District People's Hospital,13 patients at the Department of Neurosurgery,the Third People's Hospital of Jingdezhen and 104 patients at the Department of Neurosurgery,Huashan Hospital,Fudan University.Clinical and imaging follow-up were performed.The degree of embolization and clinical outcome were assessed by Raymond grade and modified Rankin Scale(mRS)respectively.The mRS score of≤2 points was defined as good outcome and the mRS score of≥3 points as poor outcome.ResultsOf 174 aneurysms,106(60.9%)were treated by Leo stent-assisted coiling,and the remaining 68(39.1%)by Leo stents alone.A total of 176 Leo stents were successfully released in 152 patients.Poor opening or anchoring of stents occurred in 9 cases(5.9%)and thrombosis events in 15 cases(9.9%)during procedure.Seven patients(4.6%)developed ischemic symptoms,of which 5 patients(3.3%)had poor outcome during perioperative period.No stent-related bleeding events occurred in 152 cases.Immediate postoperative DSA showed that the rate of excellent embolization(RaymondⅠ-Ⅱ)in small and medium aneurysms were 93.8%(60/64)and 90.5%(76/84)respectively,which was significantly higher than that in large or giant aneurysms(42.3%,11/26)(χ2=41.77,P<0.001).A total of 78 patients(51.3%)with 82 aneurysms had clinical and angiographic follow-up for an average of 11.8±6.5 months(3-23 months)and the rate of excellent embolization remained stable.However,10 patients(12.8%,10/78)had an intra-stent stenosis or occlusion of parent artery and 9 of them were asymptomatic.Among the 78 patients,76(97.4%)had good outcome and 2(2.6%)had poor outcome.Conclusions Leo stent seems safe and effective in the EVT of aneurysms,particularly f

关 键 词：颅内动脉瘤 血管内操作 治疗结果 Leo支架 安全性 有效性 

分 类 号：R651.12[医药卫生—外科学]