支架置入方案在单支架辅助弹簧圈栓塞颅内分叉处宽颈动脉瘤中的应用效果  

Efficacy of stent implantation scheme on single stent-assisted coiling for the treatment of intracranial wide-necked bifurcation aneurysms

作　　者：张化彪[1] 张晓燕 郑国墩 马波[1] 李亚华[1] 韩新巍[1] Zhang Huabiao;Zhang Xiaoyan;Zheng Guodun;Ma Bo;Li Yahua;Han Xinwei(Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurology,Zhengzhou Guancheng District People′s Hospital,Zhengzhou 450009,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州450052 [2]郑州市管城区人民医院神经内科,郑州450009

出　　处：《中华神经外科杂志》2024年第7期664-669,共6页Chinese Journal of Neurosurgery

基　　金：郑州大学横向合作科研基金 (24110011)。

摘　　要：目的探讨支架置入方案在单支架辅助弹簧圈(SSAC)栓塞未破裂颅内分叉处宽颈动脉瘤(WNBA)中的应用效果。方法回顾性分析2022年4月至2023年5月郑州大学第一附属医院介入医学部收治的39例未破裂WNBA患者的临床资料。纳入采用支架置入方案且行SSAC栓塞治疗的患者共22例(SSAC组),即单支架置入边支的选择依次遵循"远(远端边支)""大(边支角度大)""粗(边支内径大)"的原则;同时纳入采用双支架辅助弹簧圈(DSAC)栓塞治疗的17例患者(DSAC组)。比较两组患者的年龄、性别,动脉瘤的部位、大小、是否为单发、合并子囊的数量,术前Hunt-Hess分级,术中支架内血栓形成的比例。采用Raymond-Roy栓塞分级评估术后即刻栓塞程度。出院时和术后3~6个月临床随访时,采用改良Rankin量表评分(mRS)评估患者的神经功能预后;通过影像学随访评估有无支架内狭窄和Raymond-Roy栓塞分级。结果术前两组患者的年龄、性别,动脉瘤的大小、是否为单发、合并子囊数量,术前Hunt-Hess分级的差异均无统计学意义(均P>0.05)。两组动脉瘤部位的差异具有统计学意义(P<0.05)。SSAC组与DSAC组术后即刻(21/22对比17/17)和随访期(12/15对比14/14)完全栓塞比例的差异均无统计学意义(均P>0.05)。SSAC组的术中支架内血栓形成比例(3/22对比10/17)、出院时和随访期的中位mRS(均为0分对比2分)以及随访期支架内狭窄发生比例(1/15对比7/14)均低于DSAC组(均P<0.05)。结论运用支架置入方案行SSAC栓塞的未破裂WNBA患者可获得与采用DSAC栓塞患者相当的致密栓塞程度和更佳的预后,且并发症少。Objective To investigate the efficacy of stent implantation scheme in single stent-assisted coiling(SSAC)for the treatment of intracranial wide-necked bifurcation aneurysms(WNBA).Methods This retrospective analysis was performed on clinical data of 39 patients with unruptured WNBA admitted to the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from April 2022 to May 2023.Twenty-two patients(SSAC group)were treated with SSAC based on the stent implantation scheme,of which side branches were selected to implant stents according to the principle of"distal side branch,large angular side branch,and large diameter side branch".Seventeen patients with WNBA who were treated with double stent-assisted coiling(DSAC)were enrolled in this study(defined as DSAC group).Patients in the two groups were compared on age,gender and the aneurysm location,aneurysm size,single aneurysm or multiple aneurysms,the number of daughter sac and Hunt-Hess scale(HHS)before operation as well as the ratio of in-stent thrombosis during the operation.The degree of aneurysm occlusion was evaluated based on the Raymond-Roy Occlusion Classification(RROC).The modified Rankin Scale(mRS)score was used to assess neurological function both at discharge and 3 to 6 months post operation.Furthermore,patients were reexamined on in-stent stenosis and RROC by imaging follow-up.Results There was no statistically significant difference between two groups on age,gender,aneurysm size,single aneurysm or multiple aneurysms,the number of daughter sac,or HHS before operation(all P>0.05).The difference in aneurysm location between the two groups was statistically significant(P<0.05).There was no statistically significant difference between SSAC group and DSAC group on the proportion of complete occlusion of the aneurysm,which were respectively 21/22 vs.17/17 immediately after operation and 12/15 vs.14/14 during follow-up period(both P>0.05).However,patients in SSAC group had lower ratio in intraoperative stent thrombosis(3/

关 键 词：颅内动脉瘤 血管内操作 治疗结果 支架置入方案 分叉处宽颈动脉瘤 单支架辅助弹簧圈栓塞 

分 类 号：R743[医药卫生—神经病学与精神病学]