支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的多中心临床分析  

Stent-assisted coil embolization in acute intracranial ruptured wide-necked aneurysms:a multicenter clinical analysis

作　　者：曾恒 钟鸣 杨楠 李振均 李西锋[1] 段传志[1] 钟鸣[2] 邓剑平 胡鹏[4] 何旭英[1] Zeng Heng;Zhong Ming;Yang Nan;Li Zhenjun;Li Xifeng;Duan Chuanzhi;Zhong Ming;Deng Jianping;Hu Peng;He Xuying(National Key Clinical Specialty,Engineering Research Center of Education Ministry of China,Guangdong Key Laboratory of Brain Function Repair and Regeneration,Neurosurgery Institute of Guangdong Province,Cerebrovascular Disease Department of Neurosurgery Center,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China;Department of Neurosurgery,First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;Department of Neurosurgery,Tangdou Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]南方医科大学珠江医院神经外科中心脑血管病外科,国家临床重点专科,脑血管病诊断与治疗教育部工程研究中心,广东省普通高校脑功能修复与再生重点实验室,广东神经外科研究所,广州510282 [2]温州医科大学附属第一医院神经外科,温州325015 [3]空军军医大学唐都医院神经外科,西安710032 [4]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华神经医学杂志》2023年第7期657-665,共9页Chinese Journal of Neuromedicine

基　　金：国家重点研发计划(2016YFC1300800);广东省自然科学基金(2021A1515010980)。

摘　　要：目的观察支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的有效性和安全性,探讨围手术期不同抗血小板药物方案的安全性,分析影响患者预后的危险因素。方法前瞻性纳入4家医院神经外科自2017年6月至2020年1月采用支架辅助弹簧圈栓塞治疗的417例颅内破裂宽颈动脉瘤患者(温州医科大学附属第一医院41例,南方医科大学珠江医院100例,空军军医大学唐都医院111例,首都医科大学宣武医院165例)。根据围手术期抗血小板药物方案的不同将患者分为负荷量氯吡格雷组(n=87)、负荷量氯吡格雷联合阿司匹林组(n=212)、替罗非班组(n=118),比较3组患者临床资料、围手术期并发症的差异。出院时采用改良Rankin量表(mRS)评价患者的预后,比较预后不良组和预后良好组患者临床资料的差异,采用多因素Logistic回归分析筛选出影响颅内破裂宽颈动脉瘤患者预后的独立危险因素,采用受试者工作特征曲线(ROC)分析各危险因素对患者预后不良的预测价值。结果术后即刻动脉瘤栓塞程度:Raymond分级Ⅰ级351例(84.2%),Ⅱ级44例(10.6%),Ⅲ级22例(5.2%)。围手术期发生手术相关并发症44例(10.6%),死亡4例(1%)。负荷量氯吡格雷组、负荷量氯吡格雷联合阿司匹林组、替罗非班组患者术中血栓形成率分别为5.7%(5/87)、5.7%(12/212)、0.8%(1/118),替罗非班组患者术中血栓形成率低于负荷量氯吡格雷组、负荷量氯吡格雷联合阿司匹林组,差异均有统计学意义(P<0.05)。出院时患者预后良好360例(86.3%),预后不良57例(13.7%)。多因素Logistic回归分析显示,年龄≥60岁(OR=3.407,95%CI:1.620~7.166,P=0.001)、术前Hunt-Hess分级3级(OR=11.445,95%CI:3.584~36.547,P<0.001)、术前Hunt-Hess分级4级(OR=88.951,95%CI:14.519~544.948,P<0.001)、术前Hunt-Hess分级5级(OR=64.949,95%CI:12.809~329.325,P<0.001)、置入多个支架(OR=4.709,95%CI:1.215~18.248,P=0.025)是颅内破裂宽颈动脉瘤患者预后Objective To investigate the safety and efficacy of stent-assisted coil embolization in acute intracranial ruptured wide-necked aneurysms,and explore the safety of different antiplatelet drug regimens during perioperative period and the risk factors for prognoses.MethodsA perspective multicenter study was performed.A total of 417 patients with intracranial ruptured wide-necked aneurysms treated by stent-assisted coil embolization in Neurosurgery Departments of 4 hospitals(First Affiliated Hospital of Wenzhou Medical University[n=41],Zhujiang Hospital of Southern Medical University[n=111],Tangdu Hospital of Air Force Military Medical University[n=100],and Xuanwu Hospital of Capital Medical University[n=165])from June 2017 to January 2020 were included.According to the different antiplatelet drugs regimens used in perioperative period,these patients were divided into loaded clopidogrel group(n=87),loaded clopidogrel combined with aspirin group(n=212),and tirofiban group(n=118).Clinical data and perioperative complications of 3 groups were compared.Modified Rankin scale(mRS)was used to evaluate the prognoses of patients at discharge;differences of clinical data between the poor prognosis group and good prognosis group were compared.Independent risk factors for prognoses of patients with intracranial ruptured wide-necked aneurysms were analyzed by multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive values of risk factors in poor prognosis.ResultsDegrees of aneurysm embolization immediately after surgery:Raymond grading I was noted in 351 patients(84.2%),grading II in 44 patients(10.6%),and grading III in 22 patients(5.2%).Perioperative complications were noted in 44 patients(10.6%),and death was noted in 4(1%).Intraoperative thrombosis incidence of the loaded clopidogrel group,loaded clopidogrel combined with aspirin group and tirofiban group was 5.7%(5/87),5.7%(12/212)and 0.8%(1/118);that in tirofiban group was significantly lower than that in the

关 键 词：颅内动脉瘤 破裂 支架 栓塞 抗血小板药物 预后 危险因素 

分 类 号：R651.12[医药卫生—外科学]