Pipeline血流导向装置治疗后循环颅内动脉瘤的效果观察:多中心回顾性研究  

Treatment of posterior circulation intracranial aneurysm with Pipeline embolization device:a multicenter retrospective study

作　　者：罗斌 王超 刘健[3] 张义森[3] 王坤[3] 张莹 Luo Bin;Wang Chao;Liu Jian;Zhang Yisen;Wang Kun;Zhang Ying(Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;不详)

机构地区：[1]北京大学国际医院神经外科,102206 [2]北京市神经外科研究所神经介入室 [3]首都医科大学附属北京天坛医院神经外科

出　　处：《中国脑血管病杂志》2023年第6期374-381,391,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(首发2022-1-2041);北京市医管中心人才培养计划“登峰”项目(DFL20220504)。

摘　　要：目的分析Pipeline血流导向装置(PED)治疗后循环颅内动脉瘤的临床效果。方法回顾性分析2014年11月至2019年10月期间中国14个临床中心连续纳入的接受PED治疗的后循环颅内动脉瘤患者(156例,共162个动脉瘤)的临床资料,按照解剖位置分为椎动脉瘤组和基底动脉瘤组。对比两组患者的一般资料(性别、年龄、烟酒史及既往史)、动脉瘤特点(动脉瘤部位、最大径和瘤颈宽、载瘤动脉直径、动脉瘤形状、是否破裂及是否多发)、治疗情况(重叠PED治疗、弹簧圈辅助栓塞、球囊辅助)、治疗结局(支架贴壁、术后即刻完全闭塞、是否覆盖分支血管)和术后并发症(围手术期和随访期出血、缺血及压迫症状)发生情况,并通过倾向性得分匹配控制混杂因素后对比动脉瘤闭塞效果。依据术后是否发生缺血并发症将所有患者分为缺血并发症组与无缺血并发症组,比较两组患者动脉瘤的特征及治疗结果。结果椎动脉瘤组129例,共133个动脉瘤;基底动脉瘤组27例,共29个动脉瘤。两组患者一般资料差异均无统计学意义(均P>0.05);与椎动脉瘤组比较,基底动脉瘤组动脉瘤最大径更大[14.00(9.00,22.00)mm比9.76(7.08,13.25)mm,Z=2.921,P=0.003],弹簧圈辅助栓塞治疗比例更高[55.2%(16/29)比21.1%(28/133),χ^(2)=14.010,P<0.01],术后即刻完全闭塞率更高[24.1%(7/29)比6.8%(9/133),χ^(2)=6.238,P=0.013],总缺血并发症和病死率更高[17.2%(5/29)比4.5%(6/133),χ^(2)=4.251,P=0.039;11.1%(3/27)比1.6%(2/129),P=0.037];椎动脉瘤组最终动脉瘤完全闭塞率高于基底动脉瘤组[89.5%(119/133)比58.6%(17/29),χ^(2)=14.609,P<0.01]。通过倾向性得分匹配控制动脉瘤最大径和是否弹簧圈辅助栓塞治疗后获得22对椎-基底动脉瘤配对,对比结果表明,椎动脉瘤组最终完全闭塞率明显高于基底动脉瘤组[95.5%(21/22)比50.0%(11/22),χ^(2)=11.458,P=0.001]。缺血并发症组的支架调整后释放成功和分支血管狭�Objective To analyze the clinical effect of the treatment of posterior circulation intracranial aneurysms with Pipeline embolization device(PED).Methods Data from patients with posterior circulation intracranial aneurysms who received PED treatment in 14 clinical centers in China from November 2014 to October 2019 were retrospectively analyzed.They were divided into vertebral artery aneurysm group and basilar artery aneurysm group according to the anatomical location.The baseline data(gender,age,smoking and alcohol habits and previous comorbidities),aneurysm characteristics(aneurysm location,maximum diameter and neck width,parental artery diameter,aneurysm shape,rupture status or multiple),treatment details(overlapping PED treatment,coil-assisted embolization,balloon-assisted embolization),treatment outcomes(stent apposition,complete occlusion immediately after surgery,whether branch arteries were covered),and postoperative complications(bleeding,ischemia and compression symptom during perioperative and follow-up periods)between the two groups were compared.The complete occlusion rate of these two groups of aneurysms was compared after controlling confounding factors by the propensity matching score.All patients were divided into ischemic complication group and non-ischemic complication group according to whether ischemia complication occurred after operation.The characteristics and treatment results of aneurysms in the two groups were compared.Results There were 133 aneurysms in 129 patients in the vertebral aneurysm group and 29 aneurysms in 27 patients in the basilar aneurysm group.There was no statistical significance in the general data between the two groups(all P>0.05).Basilar artery aneurysms had significant larger maximum diameter(14.00[9.00,22.00]mm vs.9.76[7.08,13.25]mm,χ^(2)=2.921,P=0.003),higher proportion of adjunctive coiling(55.2%[16/29]vs.21.1[28/133]%,χ^(2)=14.010,P<0.01),higher rate of immediate postoperative complete occlusion(24.1%[7/29]vs.6.8[9/133],χ^(2)=6.238,P=0.013),total ischemic com

关 键 词：颅内动脉瘤 后循环 血流导向装置 多中心数据 介入治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]