Tubridge和Surpass Streamline血流导向装置治疗颅内未破裂动脉瘤的疗效对比分析  

Safety and effectiveness analysis of Tubridge versus Surpass Streamline in the treatment of unruptured intracranial aneurysms

作　　者：肖景锐 赵睿 张照龙 邵黎明 谢宜兴 赵晓龙[1] 刘国平[1] 孙成建[1] 徐锐[1] Xiao Jingrui;Zhao Rui;Zhang Zhaolong;Shao Liming;Xie Yixing;Zhao Xiaolong;Liu Guoping;Sun Chengjian;Xu Rui(Department of Interventional Radiology(Shinan Branch),the Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China)

机构地区：[1]青岛大学附属医院市南院区介入医学科,266000

出　　处：《中国脑血管病杂志》2024年第12期802-812,共11页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的对比分析Tubridge血流导向装置(TFD)和Surpass Streamline血流导向装置(SFD)治疗未破裂颅内动脉瘤的有效性和安全性。方法回顾性连续纳入2020年8月至2023年12月青岛大学附属医院市南院区介入医学科收治的62例应用血流导向装置治疗的颅内未破裂动脉瘤患者的临床资料,根据应用的血流导向装置将所有患者分为TFD组(32例)和SFD组(30例)。收集患者一般资料,包括年龄、性别、既往史(高血压病、糖尿病、冠心病)、住院时间、手术时间(麻醉开始至麻醉苏醒时间)及动脉瘤位置(前循环、后循环)、动脉瘤类型(巨大动脉瘤:最大径≥25 mm、大型动脉瘤:最大径15~<25 mm、中型动脉瘤:最大径5~<15 mm、小型动脉瘤:最大径<5 mm)、动脉瘤形态(囊状动脉瘤、单纯梭形动脉瘤、夹层动脉瘤)、动脉瘤最大径、瘤颈宽度、载瘤动脉直径、术前高分辨率磁共振成像动脉瘤壁强化情况。术中参照Surpass颅内动脉瘤栓塞系统治疗大型或巨大宽颈动脉瘤的临床试验(SCENT)与Tubridge血流导向装置治疗颅内动脉瘤的临床试验(IMPACT),根据动脉瘤情况选择不同类型血流导向装置及支架直径、长度,血流导向装置置入后即刻造影,若动脉瘤瘤颈处出现“射血征”,则适量填塞弹簧圈,直至动脉瘤体部无对比剂充盈;若血流导向装置释放后即刻造影未见“射血症”,则结束手术。术后即刻造影评估载瘤动脉狭窄[通畅(狭窄率≤50%)、狭窄(狭窄率>50%)或闭塞(狭窄率100%)]情况及动脉瘤闭塞程度,采用O′Kelly-Marotta(OKM)分级对动脉瘤闭塞程度进行评估。有效性评估:术后≥1个月进行DSA随访,以末次造影结果为最终随访结果评估术后动脉瘤闭塞程度(OKM分级D级为动脉瘤完全闭塞,其他等级为动脉瘤不完全闭塞)及载瘤动脉狭窄情况。安全性评估:采用改良Rankin量表(mRS)评估患者术后末次随访时的临床疗效(mRS评分0~2分为临�Objective To compare the safety and effectiveness of two different flow diverter devices between Tubridge flow diverter(TFD)and Surpass Streamline flow diverter(SFD)in the treatment of unruptured intracranial aneurysms.Methods A retrospective analysis from August 2020 to December 2023 was performed on the clinical data of 62 cases of unruptured aneurysms in the Department of Interventional Radiology(Shinan Branch),the Affiliated Hospital of Qingdao University treated with flow diverter.According to the type of implanted stents,they were divided into TFD group(32 cases)and SFD group(30 cases),general information about patients was collected,including age,sex,and past history(hypertension,diabetes,coronary heart disease),hospitalization time,surgical time(anesthesia start to anesthesia awakening time)and aneurysm location(anterior circulation,posterior circulation),type(giant aneurysm:maximum diameter≥25 mm,large aneurysm:maximum diameter 15-<25 mm,medium aneurysm:maximum diameter 5-<15 mm,small aneurysm:maximum diameter<5 mm),aneurysm morphology(saccular aneurysm,simple fusiform aneurysm,dissecting aneurysm),aneurysm maximum diameter,aneurysm neck,parent artery diameter,aneurysm wall enhancement in preoperative high-resolution MRI scan.Different types of flow diverters were selected according to the results of Surpass intracranial aneurysm embolization system pivotal trial to treat large or giant wide neck aneurysms(SCENT)and intracranial aneurysms managed by parent artery reconstruction using Tubridge flow diverter study(IMPACT).If“ejection sign”was found at the aneurysm neck on angiography immediately after the release of flow diverters,appropriate amount of coils were packed.Tamponade until there is no contrast filling in the aneurysm body on cerebral angiography,at which time the operation is terminated.If there is no“ejection sign”immediately after the release of the flow diverter,the procedure is terminated.Angiography was performed immediately after operation to evaluate the parent artery stenosis

关 键 词：颅内动脉瘤 血流导向装置 血管内操作 动脉瘤腔内修复 

分 类 号：R651.12[医药卫生—外科学]