pipeline栓塞装置治疗大脑中动脉动脉瘤的疗效:一项回顾性多中心研究  

Clinical efficacy of pipeline embolization devices for patients with middle cerebral artery aneurysms:a retrospective multicenter study

作　　者：张莹[1] 罗斌 康慧斌 刘健[1] 张义森[1] 杨新健[1] 张鸿祺[4] 李天晓[5] 买买提力·艾沙[6] 毛国华[7] 宋冬雷 王云彦[9] 冯文峰[3] 汪阳[10] 史怀璋[11] 万杰清[12] 刘建民 管生[14] 赵元立 王超 ZHANG Ying;LUO Bin;KANG Hui-bin;LIU Jian;ZHANG Yi-sen;YANG Xin-jian;ZHANG Hong-qi;LI Tian-xiao;MAIMAITILI Aisha;MAO Guo-hua;SONG Dong-lei;WANG Yun-yan;FENG Wen-feng;WANG Yang;SHI Huai-zhang;WAN Jie qing;LIU Jian-min;GUAN Sheng;ZHAO Yuan-li;WANG Chao(Department of Interventional Neuroradiology,Beijing Neurosurgical Institute&Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Peking University International Hospital,Beijing 102200,China;Department of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Interventional Radiology,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Neurosurgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 841100,China;Department of Neurosurgery,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Neurosurgery,Shanghai Donglei Brain Hospital,Shanghai 201799,China;Department of Neurosurgery,Qilu Hospital,Shandong University,Jinan 250012,China;Department of Neurosurgery,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Neurosurgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150000,China;Department of Neurosurgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China;Department of Neurosurgery,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Interventional Neuroradiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,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,北京100070 [2]北京大学国际医院神经外科,北京102200 [3]南方医科大学南方医院神经外科,广州510515 [4]首都医科大学宣武医院神经外科,北京100053 [5]河南省人民医院介入科,郑州450003 [6]新疆医科大学第一附属医院神经外科,乌鲁木齐841100 [7]南昌大学第二附属医院神经外科,南昌330006 [8]上海冬雷脑科医院神经外科,上海201799 [9]山东大学齐鲁医院神经外科,济南250012 [10]南昌大学第一附属医院神经外科,南昌330006 [11]哈尔滨医科大学附属第一医院神经外科,哈尔滨150000 [12]上海交通大学医学院附属仁济医院神经外科,上海200120 [13]海军军医大学第一附属医院神经外科,上海200433 [14]郑州大学第一附属医院神经介入科,郑州450052

出　　处：《中国临床神经外科杂志》2023年第4期225-229,共5页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(82072036,82272092);首发重点攻关项目(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pipeline栓塞装置(PED)治疗大脑中动脉(MCA)动脉瘤的临床效果。方法 回顾性分析2014年11月至2019年10月我国14个临床中心采用PED治疗的33例MCA动脉瘤的临床资料、影像学资料和随访资料。结果 33例共39个动脉瘤,使用37个PED。33例完成临床随访,30例(36个动脉瘤)完成影像随访;随访时间4~22个月,平均(10.6±6.3)个月;动脉瘤完全或近全闭塞30个(83.3%,30/36);相对于单纯PED治疗组(71.4%),PED辅助弹簧圈栓塞组动脉瘤闭塞率更高(100%;P=0.031);预后不良(m RS评分>2分)3例(9.1%),预后良好(mRS评分≤2分)30例(90.9%);术后并发症发生率为24.2%(8/33),术前规律服用双抗药物3 d以上病人术后并发症发生率明显低于未规律服用双抗药物的病人(P=0.033)。结论 MCA动脉瘤可以采用PED治疗,疗效较满意。对于直径大、形态不规则的MCA动脉瘤,可使用PED结合弹簧圈栓塞治疗以获得更高的闭塞率。术前、术后应规范应用双抗药物以减少缺血、出血并发症。Objective To investigate the clinical efficacy of pipeline embolization devices(PED)for patients with middle cerebral artery(MCA)aneurysms.Methods The clinical data,imaging data and follow-up data of 33 patients with MCA aneurysms treated with PED in 14 clinical centers from November 2014 to October 2019 were retrospectively analyzed.Results Thirty-seven PEDs were used in 33 patients with 39 MCA aneurysms.Clinical follow-up was completed in 33 patients and imaging follow-up was completed in 30 patients(36 aneurysms).The follow-up time ranged from 4 to 22 months,with an average of(10.6±6.3)months.Complete or near complete occlusion of aneurysms were achieved in 30 aneurysms(83.3%,30/36).Compared with the patients treated with PED alone[71.4%(15/21)],the occlusion rate of aneurysms was significantly higher in the patients treated with PED-assisted coil embolization[100%(15/15);P=0.031].Thirty patients(90.9%)had good prognoses(mRS score≤2),and 3(9.1%)had poor prognoses(mRS score>2).The incidence of postoperative complications was 24.2%(8/33),and patients who received dual antiplatelet therapy for more than 3 days before surgery had a significantly lower incidence of postoperative complications(3.4%)compared to those who did not(50%;P=0.033).Conclusions MCA aneurysms can be treated with PED and the effectiveness is good.For MCA aneurysms with large diameter and irregular morphology,PED combined with coil embolization can obtain a higher occlusion rate.Preoperative and postoperative dual antiplatelet therapies are recommended to decrease ischemia and bleeding complications.

关 键 词：颅内动脉瘤 大脑中动脉 血流导向装置 pipeline栓塞装置(PED) 疗效 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]