血流导向装置在颅内椎基底动脉干大动脉瘤治疗中的应用  

Application of blood flow guidance device in the treatment of intracranial vertebral basilar trunk large aneurysms

作　　者：王均 夏坤伟 徐伟 WANG Jun;XIA Kunwei;XU Wei(Yibin Second People’s Hospital,Yibin 644002,China)

机构地区：[1]宜宾市第二人民医院,四川宜宾644002

出　　处：《中国实用神经疾病杂志》2024年第10期1259-1264,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省卫生和计划生育委员会科研课题(重点研究项目)(编号:20ZD002)。

摘　　要：目的探讨血流导向装置在颅内椎基底动脉干大动脉瘤(VBTLAs)治疗中的应用价值。方法回顾宜宾市第二人民医院2018-01—2023-08治疗的45例颅内VBTLAs患者的临床资料,其中采用血流导向装置治疗者20例(A组),采用支架辅助弹簧圈栓塞治疗者25例(B组),对比2组治疗效果、预后、术后复查结果及颅脑血流动力学等。结果2组患者术后支架置入成功率均为100%,A组、B组术后即刻动脉瘤完全栓塞率(90.00%比80.00%)比较无统计学差异(P>0.05)。A组手术时间短于B组(P<0.05),但2组住院时间比较无统计学差异(P>0.05)。A、B组围术期及随访期间并发症发生情况及出院时、术后6个月的预后结局比较无统计学差异(P>0.05)。A组、B组术后6个月时分支血管通畅率(85.00%比92.00%)比较无统计学差异(P>0.05)。A组术后2d时瘤腔内平均壁面应切力(WSS)、瘤颈与载瘤动脉的血流速度低于B组,低壁面剪应力区域(LSA)、瘤腔内的相对滞留时间(RRT)及患侧大脑中动脉的血流速度高于B组(P<0.05)。结论血流导向装置对颅内VBTLAs患者的动脉瘤栓塞率、预后结局与支架辅助弹簧圈栓塞一致,但可改善患者血流动力学。Objective To investigate the application value of blood flow guidance device in the treatment of intracranial vertebral basilar trunk large aneurysms(VBTLAs).Methods A retrospective study was conducted on the clinical data of 45 patients with intracranial VBTLAs admitted to Yibin Second People’s Hospital from January 2018 to August 2023.Among them,20 patients(Group A)were treated by blood flow guidance device,and 25 patients(Group B)were treated by stent-assisted coil embolization.The treatment effects,prognosis,postoperative follow-up results,and cerebral hemodynamics of the two groups were compared.Results The success rate of stent placement was 100%in both groups after surgery.There was no difference in the complete embolization rate of aneurysms immediately after surgery between Group A and Group B(90.00%vs 80.00%,P>0.05).The surgical time in Group A was shorter than that in Group B(P<0.05),but there was no significant difference in hospitalization time between the two groups(P>0.05).There were no significant differences in the total of complications during the perioperative and follow-up periods,as well as the prognostic outcomes at discharge and 6 months after surgery in Group B(P>0.05).At 2-day post surgery,the average wall surface should(WSS)and blood flow velocity of the tumor neck and parent artery in Group A were lower than those in Group B.The low shear area(LSA),relative residence time(RRT),and blood flow velocity of the affected middle cerebral artery in Group A were higher than those in Group B(P<0.05).Conclusion The embolization rate and prognosis of intracranial VBTLAs patients with blood flow guidance devices are consistent with stent-assisted coil embolization,but blood flow guidance devices can improve patients’hemodynamics.

关 键 词：颅内椎基底动脉干大动脉瘤 血流导向装置 支架辅助弹簧圈栓塞 动脉瘤栓塞率 预后 脑血流动力学 

分 类 号：R743[医药卫生—神经病学与精神病学]