血流导向装置治疗颅内未破裂动脉瘤的围手术期并发症分析  

Analysis of perioperative complications of flow-diverter devices in the treatment of unruptured intracranial aneurysms

作　　者：王晓辉[1] 张荣举[1] 田楠 杜志华[1] 刘新峰[1] 吕斌[1] 边洋 曹向宇[1] 王君[1] Wang Xiaohui;Zhang Rongju;Tian Nan;Du Zhihua;Liu Xinfeng;Lyu Bin;Bian Yang;Cao Xiangyu;Wang Jun(Department of Neurointervention,Department of Neurology,the First Medical Center of Chinese People′s Liberation Army General Hospital,Beijing100853,China;Department of Neurology,Zaozhuang Mining Industry Group Central Hospital,Zaozhuang277000,China)

机构地区：[1]解放军总医院第一医学中心神经内科医学部神经介入科,北京100853 [2]山东国欣颐养集团枣庄中心医院神经内科,枣庄277000

出　　处：《中华外科杂志》2024年第12期1094-1103,共10页Chinese Journal of Surgery

摘　　要：目的探讨血流导向装置治疗颅内未破裂动脉瘤的围手术期不良事件和并发症发生情况。方法本研究为回顾性病例系列研究。回顾性分析2020年1月至2024年1月解放军总医院第一医学中心神经内科医学部神经介入科使用血流导向装置治疗的174例颅内未破裂动脉瘤患者的临床和影像学资料。男性63例,女性111例,年龄(53.9±11.4)岁(范围:23~76岁)。收集并分析患者围手术期不良事件和并发症的发生、发展及转归情况。采用O′Kelly-Marotta(OKM)分级系统评估动脉瘤栓塞程度,以OKM分级C级或D级为成功闭塞。结果174例患者(294个动脉瘤)共植入血流导向装置187枚(7种品牌),行单纯支架栓塞151例次,联合弹簧圈辅助栓塞26例次,同时使用2枚血流导向装置5例次。29例(16.7%,29/174)患者发生围手术期不良事件,包括支架打开不良10例、支架陷入瘤腔3例、导丝异常走位1例、穿支动脉闭塞4例、支架内血栓形成5例、脑出血3例、脑缺血3例。10例(5.7%,10/174)患者发生并发症,其中5例(2.9%,5/174)患者术后发生神经功能缺损。共129例患者(179个动脉瘤)完成术后1年随访,OKM分级D级的动脉瘤117个,C级22个,成功闭塞率为77.7%(139/179)。结论血流导向装置治疗颅内动脉瘤效果满意,但围手术期不良事件发生率较高,需要神经介入医师谨慎处理。Objective To investigate the perioperative adverse events and complications of flow-diverter devices in the treatment of unruptured intracranial aneurysms.Methods This is a retrospective case series study.The clinical and imaging data of 174 patients with unruptured intracranial aneurysms treated with flow-diverter devices in the Department of Neurointervention,Department of Neurology,the First Medical Center of Chinese People′s Liberation Army General Hospital from January 2020 to January 2024 were retrospectively analyzed.There were 63 males and 111 females,with an age of(53.9±11.4)years(range:23 to 76 years).The occurrence,development and outcome of perioperative complications and related adverse events during treatment were collected and analyzed.The degree of aneurysm embolization was evaluated using the O′Kelly-Marotta(OKM)grading system,with OKM grade C and D as successful occlusion.Results A total of 187 flow-diverter devices(from 7 different brands)were implanted in 174 patients(with 294 aneurysms).Of these,151 cases involved standalone stent embolization,26 cases involved stent embolization combined with coil assistance,and 5 cases involved the use of two flow-diverter devices simultaneously.Twenty-nine cases(16.7%,29/174)suffered intraoperative adverse events,including 10 cases of poor stents deployment,3 cases of stents migration into the aneurysm sac,1 cases of abnormal guidewire movement,4 cases of ischemic events.Complications occurred in 10 patients(5.7%,10/174),and neurological deficits occurred in 5 patients(2.9%,5/174).A total of 129 patients completed follow-up for more than 12 months after surgery.There were 117 aneurysms with OKM grade D and 22 with OKM grade C,showing a satisfactory healing rate of 77.7%(139/179).Conclusion The effect of flow-diverter devices in the treatment of intracranial aneurysms is satisfactory,but complications and adverse events cannot be ignored,especially the relatively high incidence of perioperative adverse events,which requires neurointerventional physicia

关 键 词：动脉瘤 颈动脉疾病 未破裂颈内动脉瘤 血流导向装置 颅内动脉瘤 并发症 不良事件 

分 类 号：R651.12[医药卫生—外科学]