血流导向装置治疗椎动脉夹层动脉瘤疗效分析  

Preliminary efficacy analysis of the flow diverter in the treatment of vertebral artery segment dissecting an⁃eurysm

作　　者：姜世豪 夏源 艾孜买提江·吐尔逊 伊力亚尔·地力夏提 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] 尼扎米丁江·热夏提 JIANG Shihao;XIA Yuan;TUERXUN Aizimaitijiang;DILIXIATI Yiliyaer;WANG Kai;AXIER Aximujiang;KADEER Kaheerman;SU Riqing;WANG Zengliang;CHENG Xiaojiang;AISHA Maimaitili;REXIATI Nizamidingjiang(Department of Neurosurgery,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中心,乌鲁木齐830054 [2]新疆医科大学护理学院

出　　处：《中国神经精神疾病杂志》2024年第6期355-359,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：“十三五”国家重点研发计划(编号:2016YFC1300800)。

摘　　要：目的探讨Pipeline血流导向装置(pipeline embolization divice,PED)治疗椎动脉夹层动脉瘤(vertebral artery dissecting aneurysm,VADA)的安全性及疗效。方法回顾性收集2019年1月至2023年6月新疆医科大学第一附属医院神经外科采用PED治疗的21例VADA患者的临床资料,记录手术方式、围手术期并发症、影像学结果并进行随访。以改良Rankin量表评分(mRS)评估患者预后,影像学随访采用Kamran分级。结果21例患者中未破裂动脉瘤17例,破裂动脉瘤4例。共置入22枚PED,其中13例患者接受单纯PED置入,8例患者接受PED联合弹簧圈栓塞,技术成功率21/21。3例破裂动脉瘤患者近端合并有狭窄,1例患者狭窄率>50%,因此额外放置了1枚Solitaire支架进行支架内后扩张。术后即时Kamran分级1级16例,2级1例,3级4例。围手术期并发症2例,1例患者发生动脉瘤术后破裂,1例患者肺部重症感染最终死亡。出院时mRS评分1分15例,2分2例,3分1例,4分1例,6分2例。18例患者获得随访,中位随访时间为12.5(6~30)个月,其中mRS评分0分13例,1分4例,2分1例;Kamran分级2级2例,3级4例,4级12例。结论采用PED治疗VADA手术成功率高、安全性好,但围手术期并发症不可忽视,未来仍需大量样本进一步研究。Objective A preliminary study of the safety and efficacy of the Pipeline embolization device(PED)for the treatment of vertebral artery dissecting aneurysm(VADA).Methods Clinical data of 21 patients with VADA treated with PED in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to June 2023 were retrospectively collected,and the surgical approach,perioperative complications,and imaging results were recorded and followed up.Patients'prognosis was assessed by modified Rankin Scale score(mRS),and Kamran grading was used for imaging follow-up.Results Of the 21 patients,17 had unruptured aneurysms and 4 had ruptured aneurysms.A total of 22 PEDs were placed,of which 13 patients underwent PED placement alone and 8 patients underwent PED combined with coil embolization,with a technical success rate of 100%.Three patients with ruptured aneurysms had combined stenosis proximal to the aneurysm,and 1 patient with>50%stenosis received an additional Solitaire stent for in-stent posterior dilatation.Immediate postoperative Kamran grading was grade 1 in 16 patients,grade 2 in 1 patient,and grade 3 in 4 patients.There were 2 perioperative complications,including postoperative aneurysm rupture in 1 patient and severe pulmonary infection in 1 patient who eventually died.At the time of discharge,15 patients had an mRS score of 1,2 patients had a score of 2,1 patient had a score of 3,1 patient had a score of 4,and 2 patient had a score of 6.Eighteen patients were followed up with a median follow-up time of 12.5(6-30)months,of which 13 patients had an mRS score of 0,4 patients had a score of 1,and 1 patient had a score of 2.There were 2 patients with a Kamran grade of 2,4 patients with a grade of 3,and 12 patients with a grade of 4.Conclusion The surgical success rate and safety of VADA treatment with PED is high,but perioperative complications and postoperative care should not be ignored either and a large number of samples are still needed for further study in the future.

关 键 词：血流导向装置 血管内治疗 椎动脉 夹层动脉瘤 临床疗效 

分 类 号：R741[医药卫生—神经病学与精神病学]