Neuroform Atlas支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的安全性及有效性研究  

Safety and efficacy of Neuroform Atlas stent assisted coil embolization of intracranial wide-necked aneurysms

作　　者：陈希恒 张海龙 李明涛 刘东 马立新 刘赫[1] 吕明[2] 汪阳 Chen Xiheng;Zhang Hailong;Li Mingtao;Liu Dong;Ma Lixin;Liu He;Lyu Ming;Wang Yang(Department of Neurosurgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京朝阳医院神经外科,北京100020 [2]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《中华神经医学杂志》2024年第10期992-998,共7页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(82271319)。

摘　　要：目的探讨Neuroform Atlas支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的安全性、有效性及手术相关并发症的危险因素。方法回顾性收集自2021年1月至2024年2月于首都医科大学附属北京朝阳医院神经外科接受Neuroform Atlas支架辅助弹簧圈栓塞治疗的367例颅内宽颈动脉瘤患者(共374个动脉瘤)的临床资料,分析患者的临床预后、术后即刻和术后6~12个月血管造影情况以及手术相关并发症(包括围手术期并发症和随访期并发症)发生情况等,并应用单变量及多变量Logistic回归分析明确手术相关并发症的独立危险因素。结果374个动脉瘤中,术后即刻Raymond-Roy闭塞分级(RROC)Ⅰ级323个(86.4%)、Ⅱ级42个(11.2%)、Ⅲ级9个(2.4%)。26例(7.1%)患者发生围手术期并发症,其中19例(5.2%)为缺血性并发症,7例(1.9%)为出血性并发症。共计260个(69.5%)动脉瘤进行了随访期血管造影,其中RROCⅠ级229个(88.1%)、Ⅱ级25个(9.6%)、Ⅲ级6个(2.3%)。随访期间5例(1.9%)患者发生支架内狭窄,但仅1例发生短暂性脑缺血发作,且均无边支血管闭塞事件发生。截至最后一次随访时,10例(2.7%)患者预后不良,包括8例(2.2%)重度残疾[改良Rankin量表(mRS)3分7例、4分1例]和2例(0.5%)死亡(mRS评分6分)。多变量Logistic回归分析显示,大型动脉瘤及后循环动脉瘤是手术相关并发症的独立危险因素(OR=6.299,95%CI:1.131~35.094,P=0.036;OR=3.654,95%CI:1.478~9.035,P=0.005)。结论Neuroform Atlas支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤具有较好的安全性及有效性,其中大型动脉瘤及后循环动脉瘤患者更易发生手术相关并发症。ObjectiveTo explore the safety and efficacy of Neuroform Atlas stent assisted coil embolization in intracranial wide-necked aneurysms,and analyze the risk factors for procedure-related complications.MethodsA retrospective analysis was performed;the clinical data of 367 patients with 374 intracranial wide-necked aneurysms accepted Neuroform Atlas stent assisted coil embolization from January 2021 to February 2024 were collected.Clinical prognosis,immediate postoperative and 6-12 months postoperative angiography,and procedure-related complications(including perioperative complications and complications during follow-up)were analyzed.Univariate and multivariate Logistic regression analyses were used to identify the independent risk factors for procedure-related complications.ResultsImmediate postoperative Raymond-Roy Occlusion Classification(RROC)grading I was noted in 323 aneurysms(86.4%),grading II in 42 aneurysms(11.2%),and grading III in aneurysms(2.4%).Perioperative complications occurred in 26 patients(7.1%):19(5.2%)were ischemic complications,while 7(1.9%)were hemorrhagic complications.A total of 260 aneurysms(69.5%)underwent follow-up angiography,including 229 aneurysms(88.1%)with RROC grading I,25 aneurysms(9.6%)with grading II and 6 aneurysms(2.3%)with grading III.During the follow-up,5 patients(1.9%)developed stent stenosis,but only 1 patient had transient ischemic attack,and all of them had boundless vessel occlusion.At the last follow-up,10 patients(2.7%)had poor prognosis,including 8(2.2%)with severe disabilities(7 with modified Rankin Scale[mRS]scores of 3 and 1 with mRS scores of 4),and 2(0.5%)deaths(mRS scores of 6).Multivariate Logistic regression analysis showed that large aneurysms and posterior circulation aneurysms were independent risk factors for procedure-related complications(OR=6.299,95%CI:1.131-35.094,P=0.036;OR=3.654,95%CI:1.478-9.035,P=0.005).ConclusionNeuroform Atlas stent assisted coil embolization in intracranial wide-necked aneurysms is safe and feasible;patients with large aneurysm

关 键 词：Neuroform Atlas支架 弹簧圈 宽颈动脉瘤 并发症 血管内治疗 

分 类 号：R651.12[医药卫生—外科学]