急性期破裂颅内宽颈动脉瘤一期支架辅助治愈性栓塞的临床研究  

Efficacy and safety of stent-assisted curative embolization in treatment of acutely ruptured intracranial wide-necked aneurysms

作　　者：张贤 鲍娟[1] 曹毅[1] 景睿[1] 薛思博 ZHANG Xian;BAO Juan;CAO Yi;JING Rui;XUE Sibo(Department of Cerebrovascular Diseases,The Second Affiliated Hospital,Kunming Medical University,Kunming,Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院脑血管病科,云南昆明650101

出　　处：《国际神经病学神经外科学杂志》2024年第6期1-9,共9页Journal of International Neurology and Neurosurgery

基　　金：云南省教育厅科学研究基金(2023Y0638)。

摘　　要：目的分析一期采用支架辅助弹簧圈治愈性栓塞急性期破裂颅内动脉瘤的疗效及安全性。方法研究2017年1月—2022年10月昆明医科大学第二附属医院收治的205例采用血管内治疗的颅内动脉瘤破裂至蛛网膜下腔出血患者,收集临床资料包括一般资料、手术方法、Raymond分级评估即刻及末次随访栓塞率、围手术期及随访期并发症,改良Rankin量表评估临床预后。结果205例患者中,支架辅助弹簧圈栓塞(SAC)组77例,单纯弹簧圈栓塞(NSC)组128例。术后即刻RaymondⅠ级栓塞率SAC组76.6%与NSC组的75.0%比较,差异无统计学意义(P>0.05)。188例患者获得临床随访,85例患者获得至少1次DSA随访。末次随访Ⅰ级栓塞SAC组97.4%(37/38),NSC组91.5%(43/47);复发SAC组3例(3/38,7.9%),NSC组9例(9/47,19.1%),两组间比较差异均无统计学意义(P>0.05)。术中总并发症发生率SAC组13.0%(10/77)与NSC组的9.4%(12/128)比较,差异无统计学意义(P>0.05);术后1个月内发生动脉瘤再破裂出血SAC组7例(9.1%),较NSC组1例(0.8%)增高,但总并发症发生率SAC组(18/77,23.4%)与NSC组(20/128,15.6%)比较,差异无统计学意义(P>0.05)。至随访终点,两组间总死亡率与预后良好率比较,差异均无统计学意义(P>0.05)。结论SAC治疗急性期破裂动脉瘤安全有效,支架的使用未增加缺血事件发生的风险,抗血小板药物亦不增加术中出血性事件发生率,但仍应警惕由于动脉瘤未完全致密栓塞时抗血小板治疗带来的术后出血风险。SAC是否能降低动脉瘤的复发率还有待进一步明确。Objective To investigate the efficacy and safety of stent-assisted coil curative embolization in the treatment of acutely ruptured intracranial aneurysms.Methods A retrospective analysis was performed for 205 patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms who received endovascular treatment in Department of Cerebrovascular Diseases,The Second Affiliated Hospital of Kunming Medical University,from January 2017 to October 2022.Related clinical data were collected,including general status,surgical methods,embolization rate immediately after surgery and at last follow-up based on the Raymond classification,and complications during the perioperative period and follow-up,and the modified Rankin Scale was used to evaluate clinical prognosis.Results Among the 205 patients,77 were enrolled in the stent-assisted coiling(SAC)group and 128 were enrolled in the non-stent coiling(NSC)group.There was no significant difference in the rate of Raymond grade I embolization immediately after surgery between the SAC group and the NSC group(76.6%vs 75.0%,P>0.05).Clinical follow-up was performed for 188 patients,with 85 patients receiving at least one session of DSA follow-up.There were no significant differences between the SAC group and the NSC group in the rate of grade I embolization at last follow-up[97.4%(37/38)vs 91.5%(43/47),P>0.05]and recurrence rate[7.9%(3/38)vs 19.1%(9/47),P>0.05].There was no significant difference in the incidence rate of intraoperative complications between the SAC group and the NSC group[13.0%(10/77)vs 9.4%(12/128),P>0.05].Within 1 month after surgery,7 patients(9.1%)in the SAC group and 1 patient(0.8%)in the NSC group experienced rebleeding of aneurysms,and there was no significant difference in the incidence rate of complications between the SAC group and the NSC group[23.4%(18/77)vs 15.6%(20/128),P>0.05].At the end of follow-up,there were no significant differences between the two groups in overall mortality rate and good prognosis rate(P>0.05).Conclusions SAC is safe and

关 键 词：颅内破裂动脉瘤 支架辅助栓塞 安全性 有效性 

分 类 号：R743[医药卫生—神经病学与精神病学]