血流导向装置治疗颅内破裂动脉瘤的安全性及疗效分析  

Analysis of the safety and efficacy of blood flow diverter in the treatment of intracranial ruptured aneurysm

作　　者：姜世豪 尼扎米丁江·热夏提 李映婷 王凯[1] 阿西木江·阿西尔 卡合尔曼·卡德尔[1] 苏日青[1] 王增亮[1] 成晓江[1] 买买提力·艾沙[1] Jiang Shihao;Nizamidingjiang Rexiati;Li Yingting;Wang Kai;Aximujiang Axier;Kaheerman Kader;Su Riqing;Wang Zengliang;Cheng Xiaojiang;Maimaitili Aisha(Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Therapy Centre,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054 [2]新疆医科大学第一附属医院介入治疗中心,乌鲁木齐830054

出　　处：《中华神经外科杂志》2024年第7期659-663,共5页Chinese Journal of Neurosurgery

基　　金："十三五"国家重点研发计划(2016YFC1300800)。

摘　　要：目的探讨血流导向装置(FD)在治疗颅内破裂动脉瘤患者中的安全性及疗效。方法回顾性分析2019年1月至2021年12月新疆医科大学第一附属医院神经外科采用FD治疗的28例颅内破裂动脉瘤患者(共28个动脉瘤)的临床资料。其中,男8例,女20例;年龄为(55.6±14.0)岁。18例患者接受Pipeline栓塞装置(PED)治疗,10例患者接受Tubridge FD治疗。记录围手术期并发症情况。所有患者于术后6~24个月住院行数字减影血管造影(DSA)检查,采用Kamran分级评估动脉瘤的栓塞情况(Kamran分级4级为完全栓塞);并根据改良Rankin量表评分(mRS)评价患者的预后(mRS 0~2分为预后良好)。结果28例患者共使用30枚FD支架,其中2例患者使用了2枚支架;19例患者联合弹簧圈治疗。28例患者中,6例(21.4%)出现围手术期并发症,其中5例(17.8%)为出血性并发症,1例(3.6%)为缺血性并发症;病死率为7.1%(2/28)。28例患者中,25例获得随访,中位随访时间为14(6~24)个月。至末次随访,动脉瘤Kamran分级2级1例,3级2例,4级22例,动脉瘤完全闭塞率为88.0%(22/25);mRS 0~2分21例,3~6分7例,预后良好率为75.0%(21/28)。结论FD治疗颅内破裂动脉瘤患者的围手术期并发症发生率较低,短、中期随访动脉瘤闭塞率较高,具有较好的安全性和有效性。Objective To explore the safety and efficacy of flow diverter(FD)in the treatment of patients with intracranial ruptured aneurysm.Methods The clinical data of 28 patients with intracranial ruptured aneurysms(28 aneurysms in total)treated with FD at the Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2021 were retrospectively analyzed.Among them,there were 8 males and 20 females;the age was 55.6±14.0 years old.Eighteen patients were treated with Pipeline embolization device(PED),and 10 patients were treated with Tubridge FD.Perioperative complications were recorded.All patients were hospitalized for digital subtraction angiography(DSA)examination 6 to 24 months after surgery,and the Kamran grade was used to evaluate the embolization of the aneurysm(Kamran grade 4 as complete embolization);the modified Rankin scale(mRS)to evaluate the patient′s outcome(mRS of 0 to 2 points as good outcome).Results A total of 30 FD stents were used in 28 patients,of which 2 patients used 2 stents;19 patients were treated with combined coils.Among the 28 patients,6(21.4%)experienced perioperative complications,of which 5(17.8%)were hemorrhagic complications and 1(3.6%)were ischemic complications;the mortality rate was 7.1%(2/28).Among the 28 patients,25 were followed up,and the median follow-up time was 14(6 to 24)months.As of the last follow-up,1 case of aneurysm was Kamran grade 2,2 cases were grade 3,and 22 cases were grade 4.The aneurysm complete occlusion rate was 88.0%(22/25);21 cases had an mRS of 0 to 2,and 7 had an mRS of 3 to 6.For example,the good outcome rate was 75.0%(21/28).Conclusion As a method for the treatment of intracranial ruptured aneurysms,FD has a low perioperative complication rate and a high short-and medium-term aneurysm occlusion rate,and has good safety and effectiveness.

关 键 词：颅内动脉瘤 破裂 血管内操作 治疗结果 血流导向装置 

分 类 号：R743[医药卫生—神经病学与精神病学]