Pipeline血流导向装置治疗颅内动脉瘤术后支架内狭窄的影响因素分析  

Analysis of influencing factors on post-treatment in-stent stenosis of intracranial aneurysm using Pipeline embolization device

作　　者：司明磊 魏森[1] 管生[1] 王林玉[1] 李振东 常涛 Si Minglei;Wei Sen;Guan Sheng;Wang Linyu;Li Zhendong;Chang Tao(Department of Neurointerventional Radiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]郑州大学第一附属医院神经介入科,郑州450002

出　　处：《中华放射学杂志》2023年第1期67-72,共6页Chinese Journal of Radiology

摘　　要：目的探讨Pipeline血流导向装置(PED)治疗颅内动脉瘤术后支架内狭窄(ISS)的发生率、临床意义和影响因素。方法回顾性分析2015年4月至2021年7月在郑州大学第一附属医院神经介入科采用PED治疗的161例颅内动脉瘤患者的临床资料。PED均在患者全身麻醉后经股动脉入路植入载瘤动脉。收集患者首次DSA随访时间和影像资料,将患者分为ISS组和非ISS组。采用O′Kelly-Marotta(OKM)分级评估动脉瘤闭塞情况;采用单因素和多因素二元Logistic回归分析方法对可能与ISS相关的因素进行分析。结果161例患者共168处动脉瘤,植入179枚PED,88处(52.38%)动脉瘤采用单独PED植入,80处(47.62%)动脉瘤采用PED联合弹簧圈栓塞。中位随访时间6(5,7)个月,共有31处(18.45%)动脉瘤出现ISS,其中16处(9.52%)为轻度(<50%),13处(7.74%)为中度(50%~75%),2处(1.19%)为重度(>75%)。ISS患者均无相关临床症状,其中1处(0.60%)动脉瘤进行了球囊扩张血管成形术。单因素分析显示,支架直径、动脉瘤位置、甘油三酯、载瘤动脉远端直径和载瘤动脉近端直径与ISS发生相关。进一步进行多因素Logistic回归分析表明,支架直径(OR=0.332,95%CI 0.191~0.578,P<0.001)和甘油三酯水平(OR=1.641,95%CI 1.034~2.605,P=0.036)是ISS的独立危险因素。结论PED治疗颅内动脉瘤术后ISS是一种常见的良性并发症。支架直径较小和甘油三酯水平偏高是PED治疗颅内动脉瘤术后ISS发生的独立危险因素。Objective To evaluate the incidence,clinical significance and influencing factors on in-stent stenosis(ISS)after treatment of intracranial aneurysms by Pipeline embolization device(PED).Methods A retrospective analysis was conducted on the clinical data of 161 patients with intracranial aneurysms treated with PED at the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from April 2015 to July 2021.PED was implanted into the parent artery through the femoral artery approach after general anesthesia.The first DSA follow-up duration time and imaging data were collected,and the patients were divided into ISS group and non-ISS group accordingly.The degree of aneurysm occlusion was evaluated by O′Kelly-Marotta(OKM)grading scale.Univariate and multivariate logistic regression analysis were applied to identify the factors related to ISS.Results A total of 179 PED were employed in 161 patients with 168 aneurysms.Eighty-eight(52.38%)aneurysms were treated by PED only,and 80(47.62%)aneurysms by PED combined with coiling.After a median follow-up of 6(5,7)months,31(18.45%)aneurysms had ISS within the PED,of which 16(9.52%)cases were with mild stenosis(<50%),13(7.74%)were with moderate stenosis(50%-75%),and 2(1.19%)were with severe stenosis(>75%).All patients with ISS showed no relevant clinical symptoms.One(0.60%)patient with ISS underwent balloon angioplasty.Univariate analysis showed that the stent diameter,aneurysm location,triglyceride level,the diameter of distal parent artery,and the diameter of proximal parent artery were associated to ISS.Further multivariate logistic regression analysis showed the stent diameter(OR=0.332,95%CI 0.191-0.578,P<0.001)and triglyceride level(OR=1.641,95%CI 1.034-2.605,P=0.036)were independent factors of ISS.Conclusions ISS is a common benign complication after PED treatment.The current results suggest that small stent diameter and high triglyceride level are independent factors of ISS.

关 键 词：颅内动脉瘤 Pipeline血流导向装置 支架内狭窄 支架直径 

分 类 号：R743[医药卫生—神经病学与精神病学]