颅内未破裂动脉瘤Pipeline栓塞装置置入术后支架内狭窄的危险因素  

Risk factors for in-stent stenosis in patients with unruptured intracranial aneurysms after Pipeline embolization device implantation

作　　者：葛慧剑 桂思铭 邓丁伟 李佑祥[1,2] GE Hui-jian;GUI Si-ming;DENG Ding-wei;LI You-xiang(Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Beijing 100070,China)

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

出　　处：《中国临床神经外科杂志》2023年第7期429-432,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 探讨颅内未破裂动脉瘤(UIA)Pipeline栓塞装置(PED)置入术后内支架狭窄(ISS)的发生率、临床预后和危险因素。方法 回顾性分析2015年9月至2020年10月接受PED治疗的460例UIA的临床资料。术后6个月复查DSA评估ISS,以PED内的管腔直径较术前缩窄超过50%定义为ISS。结果 术后中位随访时间8个月(IQR:5~16个月)。在随访过程中,66例(14.3%)出现ISS,其中17例(3.7%)出现载瘤动脉闭塞。末次随访,8例ISS有所恢复,31例为轻度ISS,10例为重度ISS,17例载瘤动脉闭塞;3例出现偏瘫,1例单侧视野缺损,1例死亡,其余61例无症状;56例(84.8%)颅内动脉瘤完全闭塞。多因素logistic回归分析显示,后循环动脉瘤(OR=2.895;95%CI 1.731~4.839;P=0.001)、球囊扩张(OR=2.380;95%CI 1.154~4.912;P=0.019)是UIA病人PED置入术后发生ISS的独立危险因素。结论 ISS是UIA病人PED置入术后常见的并发症,后循环动脉瘤和球囊扩张术治疗的病人更易发生ISS。Objective To investigate the incidence,clinical prognosis and risk factors of in-stent stenosis(ISS)in patients with unruptured intracranial aneurysms(UIA)after Pipeline embolization device(PED)implantation.Methods The clinical and cerebral digital subtraction angiography(DSA)data of 460 patients with UIA who underwent PED placement from September 2015 to October 2020 were retrospectively reviewed.The DSA at 6 months after the PED implantation was used to assess the ISS,which was defined as the lumen diameter in PED was more than 50%narrower than that before the surgery.Results The median follow-up time was 8 months(IQR:5~16 months).During the follow-up,ISS occurred in 66 patients(14.3%),of whom 17 patients(3.7%)suffered from occlusion of parent arteries.At the last follow-up,8 patients with ISS were recovered,31 mild ISS,10 severe ISS,and 17 occlusion of parent arteries.Hemiplegia occurred in 3 patients,unilateral visual field defect occurred in 1 patient,and 1 patient died.Complete occlusion of aneurysms was achieved in 56 patients(84.8%)of 66 patients with ISS.Multivariate logistic regression analysis showed that posterior circulation aneurysm(OR=2.895;95%CI 1.731~4.839;P=0.001)and balloon angioplasty(OR=2.380;95%CI 1.154~4.912;P=0.019)were independent risk factors for ISS in UIA patients after PED implantation.Conclusions ISS is a common complication in UIA patients after PED implantation,and the patients with posterior circulation aneurysm or treated with balloon angioplasty are more prone to ISS.

关 键 词：颅内动脉瘤 未破裂动脉瘤 Pipeline栓塞装置 支架内狭窄 危险因素 

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]