单纯血流导向装置治疗椎-基底动脉动脉瘤的安全性及疗效分析  

Safety and efficacy analysis of flow diverter only in the treatment of vertebrobasilar aneurysms

作　　者：陈爱霞 吴培[1] 吴桥伟 李俞辰[1] 胡旭晨 姚金彪 陈平伯 史怀璋[1] 王跃华 Aixia Chen;Pei Wu;Qiaowei Wu;Yuchen Li;Xuchen Hu;Jinbiao Yao;Pingbo Chen;Huaizhang Shi;Yuehua Wang(Department of Neurosury,the First Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001;Department of Neurosury,Shanghai Senveth People's Hospital,Shanghai 200080,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,黑龙江哈尔滨150001 [2]上海市第七人民医院神经外科,上海200080

出　　处：《中华介入放射学电子杂志》2023年第3期241-246,共6页Chinese Journal of Interventional Radiology：electronic edition

基　　金：国家自然科学基金项目(82101383);中国博士后科学基金项目(MD703829)。

摘　　要：目的总结分析单纯血流导向装置(flow diverter,FD)治疗椎-基底动脉动脉瘤的安全性及临床疗效。方法回顾性分析哈尔滨医科大学附属第一医院神经外科2019年1月至2022年5月接受FD治疗椎-基底动脉动脉瘤患者的影像学及临床资料,总结分析患者术后神经系统相关并发症情况。根据改良Rankin量表(modified Rankin scale,mRS)评分评价患者接受该治疗方式的临床预后;采用O'Kelly-Marotta(OKM)分级评估患者术后影像学随访动脉瘤闭塞情况。结果纳入38例患者共40个动脉瘤,其中破裂动脉瘤1个,未破裂动脉瘤39个。所有患者共置入51枚FD,其中Pipeline血流导向装置(Pipeline embolization devices,PED)44枚,Tubridge FD 7枚,手术成功率为100%。所有FD均成功释放并贴壁完好。所有患者均获得临床随访,中位随访时间为13.0(2~47)个月。术后总体并发症发生率为13.2%(5/38),其中围手术期并发症发生率为5.3%(2/38),随访期间首次出现并发症3例(3/38,7.9%)。术后总体缺血性并发症发生率为13.2%(5/38),其中缺血合并出血性并发症2例(2/38,5.3%)。末次随访mRS>2比率为10.52%(4/38),其中死亡率为7.9%(3/38)。24例患者共26个动脉瘤获得影像学随访,中位随访时间7(5~18)个月,动脉瘤完全闭塞(OKM分级D级)16个(16/26,61.5%),动脉瘤次全闭塞(OKM分级C/D级)22个(22/26,84.60%);无动脉瘤体积进展。结论单纯FD治疗椎-基底动脉动脉瘤手术成功率高,安全性较好,术后影像学随访闭塞率高,无动脉瘤体积进展,但仍应警惕致命性缺血性并发症的发生。Objective To analyze the efficacy and safety of flow diverter(FD)only in treating vertebrobasilar aneurysms.Methods The clinical data of patients with vertebrobasilar aneurysms treated with FD in the First Affiliated Hospital of Harbin Medical University from January 2019 to May 2022 were analyzed retrospectively.Periprocedural complications were recorded and analyzed.The modified Rankin Scale(mRS)was used to evaluate the clinical outcomes,and the O'Kelly Marotta(OKM)grading scale was used to evaluate imaging outcomes.Results A total of 38 patients harbouring 40 intracranial aneurysms treated with FD were enrolled.A total of 51 FDs were implanted,including 44 Pipeline embolization devices(PED)and 7 Tunbridge FDs,with a technical success rate of 100%.All FDs were successfully released with proper stent apposition.Thirty-eight patients underwent clinical follow-up,with a median follow-up time of 13.0(2~47)months.The overall postprocedural complication rate was 13.2%(5/38).Among them,the periprocedural complication rate was 5.3%(2/28),and 3(7.9%,3/38)patients first experienced complications during the follow-up.The overall incidence of postprocedural ischemic complications was 13.2%(5/38),including 2 cases(2/38,5.3%)of ischemia complicated with hemorrhagic complications.The rate of mRS>2 at the last follow-up was 10.52%(4/38),and the mortality rate was 7.9%(3/38).A total of 24 patients with 26 aneurysms underwent imaging follow-up,with a median follow-up time of 7(5~18)months.Complete aneurysm occlusion(grade D of the OKM grading scale)was observed in 16(61.5%)patients,and adequate aneurysm occlusion(grade C/D of the OKM grading scale)was observed in 22 patients(84.60%).No aneurysm growth was observed.Conclusions FD was safe in treating vertebrobasilar aneurysms with a high procedure success rate.Imaging follow-up showed a high rate of adequate aneurysm occlusion with no growth.However,fatal ischemic complications remain to be noted.

关 键 词：血流导向装置 椎-基底动脉瘤 并发症 随访研究 

分 类 号：R743[医药卫生—神经病学与精神病学]