血流导向装置治疗颅内动脉瘤后分支血管狭窄或闭塞:多中心临床观察结果分析  

Stenosis or occlusion of covered branch after Pipeline embolization device treatment of intracranial aneurysms:multicenter clinical observation and data analysis

作　　者：张莹[1] 罗斌 王超 刘健[1] 王坤[1] 杨新健[1] 张义森[1] Zhang Ying;Luo Bin;Wang Chao;Liu Jian;Wang Kun;Yang Xinjian;Zhang Yisen(Department of Interventional Neuroradiology,Beijing Neurosurgical Institute,Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京市神经外科研究所神经介入室首都医科大学附属北京天坛医院神经外科,100070 [2]北京大学国际医院神经外科

出　　处：《中国脑血管病杂志》2023年第5期307-315,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(82072036、82272092);首都卫生发展科研专项项目(2022-1-2041);北京市医院管理中心“登峰”人才计划(DFL20220504)。

摘　　要：目的探讨应用Pipeline血流导向装置(PED)治疗颅内动脉瘤后分支血管狭窄或闭塞情况。方法回顾性分析血流导向装置治疗颅内动脉瘤中国上市后多中心注册表研究(PLUS)数据库2014年11月至2019年10月期间在中国14个临床中心连续纳入的接受PED介入治疗的1285例颅内动脉瘤患者,根据术后末次DSA随访结果分为分支通畅组和分支狭窄闭塞组,对比两组基线资料、动脉瘤特点、治疗情况、治疗结局和围手术期及随访时并发症(出血、缺血并发症)发生情况,并单独分析分支血管狭窄闭塞组分支血管情况及缺血并发症发生情况。结果分支狭窄闭塞组患者73例(5.7%),包括48例(3.7%)狭窄和25例(1.9%)闭塞,分支通畅组1212例。与分支通畅组相比,分支狭窄闭塞组术后即刻血管造影分支血管覆盖率更高[覆盖率:100.0%(73/73)比70.6%(856/1212),χ^(2)=29.659,P<0.01];术后应用他汀类降血脂药物比例更高[32.9%(24/73)比18.5%(224/1212),χ^(2)=9.160,P=0.002];随访期缺血并发症[6.8%(5/73)比0.5%(6/1212),P<0.01]、术后总缺血并发症[16.4%(12/73)比6.8%(82/1212),P=0.002]和载瘤动脉闭塞发生率[5.5%(4/73)比1.2%(14/1212),P=0.011]均更高。两组间术前应用双联抗血小板聚集药物比例、弹簧圈辅助栓塞、多支架重叠治疗单个动脉瘤、支架贴壁良好率、术后即刻动脉瘤闭塞率、末次随访动脉瘤闭塞率以及病死率等差异均无统计学意义(均P>0.05)。分支狭窄闭塞组共有79根狭窄或闭塞的分支血管,其中31.6%(25根)为完全血管闭塞;狭窄闭塞血管最多为眼动脉(43.0%,34根),其次为后交通动脉(31.6%,25根)和小脑下后动脉(11.4%,9根)。分支狭窄闭塞组12例(16.4%)发生术后缺血并发症,其中9例为眼动脉部位分支血管狭窄闭塞,2例为小脑下后动脉,1例为小脑前下动脉;围手术期发生缺血并发症8例,随访期发生缺血并发症5例,1例患者围手术期发生缺血并发症且经药物治疗后�Objective To investigate the stenosis or occlusion of covered branches after Pipeline embolization device(PED)treatment of intracranial aneurysm.Methods Retrospective analysis was performed on 1285 patients with intracranial aneurysms who received PED treatment and consecutively enrolled in 14 clinical centers in China from November 2014 to October 2019 in post-market multi-center retrospective research on the embolization of intracranial aneurysms with Pipeline embolization device in China(PLUS)database.According to the follow-up imaging,they were divided into two groups:branch patency group and branch stenosis/occlusion group.The baseline data,aneurysm characteristics,treatment details,treatment outcomes,and incidence of complications(hemorrhagic,ischemic stroke)during perioperative and follow-up periods between two groups were compared,and the characteristics of branches and the occurrence of ischemic complications in the group of branch stenosis/occlusion were further analyzed.Results There were 73 cases(5.7%)in the branch stenosis/occlusion group,including 48 cases(3.7%)had branch stenosis and 25 cases(1.9%)had branch occlusion.There were 1212 cases in the branch patency group.Compared with the branch patency group,the branch stenosis/occlusion group had higher postoperative immediate branch coverage rate on DSA(coverage rate:100.0%[73/73]vs.70.6%[856/1212],χ^(2)=29.659,P<0.01);postoperative use of lipid-lowering statin therapy was more frequently applied(32.9%[24/73]vs.18.5%[224/1212],χ^(2)=9.160,P=0.002);rates of ischemic complications during follow-up(6.8%[5/73]vs.0.5%[6/1212],P<0.01),total ischemic complications(16.4%[12/73]vs.6.8%[82/1212],P=0.002)and parent artery occlusion(5.5%[4/73]vs.1.2%[14/1212],P=0.011)were higher.There was no significant difference between the two groups in preoperative dual antiplatelet therapy,adjunctive coiling,the overlapping stents use,good vessel wall apposition rate,immediate postoperative complete occlusion rate,final follow-up complete occlusion rate,and mortality rat

关 键 词：颅内动脉瘤 血流导向装置 多中心数据 并发症 

分 类 号：R743[医药卫生—神经病学与精神病学]