Neuroform Atlas支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的疗效分析  

Therapeutic effect analysis of Neuroform Atlas stent-assisted coil embolization for acute intracranial ruptured wide-necked aneurysms

作　　者：李文帅[1] 李庆民 王奉淼 张海兵 夏卫东[1] 张信芳[1] 张全忠[1] LiWenshuai;Li Qingmin;Wang Fengmiao;Zhang Haibing;Xia Weidong;Zhang Xinfang;Zhang Quanzhong(Department of Neurosurgery,Heze Municipal Hospital,Heze 274000,China)

机构地区：[1]菏泽市立医院神经外科,菏泽274000

出　　处：《中华神经外科杂志》2024年第11期1109-1113,共5页Chinese Journal of Neurosurgery

基　　金：山东省医药卫生科技发展计划项目(202004040279)。

摘　　要：目的探讨Neuroform Atlas支架(简称Atlas支架)辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的安全性和有效性。方法回顾性分析2021年1月至2023年6月菏泽市立医院神经外科应用Atlas支架辅助弹簧圈栓塞治疗的61例急性期颅内破裂宽颈动脉瘤患者(61个动脉瘤)的临床资料。以改良Rankin量表评分(mRS)评价术后3个月的临床预后, 0~2分为预后良好;以Raymond分级评价动脉瘤即刻及随访时的栓塞程度, 评价动脉瘤的治愈(完全栓塞)率及支架内狭窄的发生率。结果 61个动脉瘤共使用64枚支架, 均成功释放。即刻栓塞结果:Raymond分级Ⅰ级43例(70.5%), Ⅱ级12例(19.7%), Ⅲ级6例(9.8%)。围手术期未发生出血性并发症, 5例(8.2%)发生缺血性并发症;死亡2例。失访2例, 57例完成术后3个月随访, 其中mRS 0分50例, 1分5例, 2分1例, 3分1例;预后良好率为94.9%(56/59)。47例患者完成数字减影血管造影随访, 随访时间为术后(7.6±1.5)个月(6~11个月);其中42例(89.4%)动脉瘤治愈, 1例(2.1%)动脉瘤稳定, 4例(8.5%)动脉瘤复发;无一例出现新发支架内狭窄。结论 Atlas支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的治愈率较高, 但缺血性并发症的发生风险亦较高。Objective To evaluate the safety and efficacy of Neuroform Atlas(Atlas)stent-assisted coil embolization of acute ruptured intracranial wide-necked aneurysms.MethodsA retrospective analysis was conducted on the clinical data of 61 patients with acute ruptured intracranial wide-necked aneurysms(61 aneurysms)treated with Atlas stent-assisted embolization at the Department of Neurosurgery,Heze Municipal Hospital from January 2021 to June 2023.The clinical outcomes were evaluated at 3 months after surgery using the Modified Rankin Scale(mRS)Score,with a score of O-2 indicating a good outcome.Raymond grade was used to evaluate the degree of embolization of the aneurysm immediately post surgery and during follow-up,and to evaluate the cure(complete embolization)rate of the aneurysm and the incidence of in-stent stenosis.Results A total of 64 stents were used in 6l aneurysms,and all were successfully released.Immediate post-embolization results showed as follows:raymond grade Ⅰ in 43 cases(70.5%),grade Ⅱ in 12 cases(19.7%),and grade Ⅲ in 6 cases(9.8%).No hemorrhagic complications occurred during the perioperative period,and ischemic complications occurred in 5 cases(8.2%);2 cases died.Two cases were lost to follow-up,and 57 cases completed the 3-month postoperative followup,including 50 cases with mRS score of 0,5 cases with 1 score,1 case with 2 scores,and 1 case with 3 scores;the good outcome rate was 94.9%(56/59).A total of 47 cases underwent DSA follow-up,and the follow-up time was 7.6±1.5 months(6 to 11 months)after surgery;42 cases(89.4%)of aneurysm were cured,1 case(2.1%)had a stable aneurysm,and 4 cases(8.5%)had aneurysm recurrence;no new in-stent stenosis occurred.Conclusion The cure rate of Atlas stent-assisted coil embolization in the treatment of acute intracranial rupture of wide-necked aneurysms seems high,but the risk of ischemic complications is also high.

关 键 词：颅内动脉瘤 动脉瘤 破裂 栓塞 治疗性 治疗结果 Atlas支架 

分 类 号：R651.12[医药卫生—外科学]