血流导向装置治疗Willis环远端动脉瘤的多中心回顾性研究  

Flow diverters in aneurysms beyond the circle of Willis:a multicenter retrospective study

作　　者：冯欣 黄驰 葛润泽 彭超[2] 郭宗铎[3] 苏世星[1] 张炘[1] 李西锋[1] 刘爱华[4] 段传志[1] Feng Xin;Huang Chi;Ge Runze;Peng Chao;Guo Zongduo;Su Shixing;Zhang Xin;Li Xifeng;Liu Aihua;Duan Chuanzhi(National Key Clinical Specialty,Engineering Technology Research Center on Diagnosis and Treatment of Cerebrovascular Diseases in Ministry of Education,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration,Department of Cerebrovascular Surgery,Neurosurgery Center,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China;Department of Neurosurgery,Guangdong Provincial People's Hospital,Guangzhou 510080,China;Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]南方医科大学珠江医院神经外科中心脑血管病外科,国家临床重点专科,脑血管病诊断与治疗教育部工程研究中心,广东省普通高校脑功能修复与再生重点实验室,广州510282 [2]广东省人民医院神经外科,广州510080 [3]重庆医科大学附属第一医院神经外科,重庆400016 [4]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》2025年第1期8-15,共8页Chinese Journal of Neuromedicine

基　　金：国家卫生健康委能力建设和继续教育中心课题(GWJJ2022100102);国家自然科学基金(82201427);广州市科技计划项目(2023A04J2426)。

摘　　要：目的探讨血流导向装置超说明书治疗Willis环远端动脉瘤的有效性及安全性。方法选择自2016年1月至2023年9月在南方医科大学珠江医院神经外科中心脑血管病外科、广东省人民医院神经外科、重庆医科大学附属第一医院神经外科、首都医科大学附属北京天坛医院神经外科接受血流导向装置治疗的71例Willis环远端动脉瘤患者为研究对象。回顾性收集患者的临床及影像学资料,并对患者的临床特征、动脉瘤特征、治疗情况、围手术期并发症发生情况以及临床、影像学随访结果进行总结分析。结果71例患者中22例(31.0%)有缺血性脑卒中病史,43例(60.6%)有高血压病史;共携带76个动脉瘤,其中前交通动脉瘤5个(6.6%)、大脑前动脉瘤10个(13.2%)、大脑中动脉瘤53个(69.7%)、大脑后动脉瘤8个(10.5%),动脉瘤最大径为5.65(3.63,10.12)mm,载瘤动脉直径为(2.70±0.57)mm。共使用了80个血流导向装置,包括38个(47.5%)Pipeline血流导向装置和42个(52.5%)Tubridge血流导向装置,植入成功率为98.8%(79/80)。7例(9.9%)患者发生围手术期并发症,其中2例(2.8%)为永久性并发症(1例为视野缺损,1例为颅内出血)。患者临床随访时间为(19.73±11.90)个月,至末次临床随访时,71例患者中68例(95.8%)预后良好(改良Rankin量表评分0~2分),10例(14.1%)发生缺血性并发症,1例(1.4%)发生出血性并发症。患者影像学随访时间为7(6,12)个月,至末次影像学随访时,67个动脉瘤中44个(65.7%)完全闭塞,10个(14.9%)发生支架内狭窄。结论本研究结果初步证实Willis环远端动脉瘤患者超说明书应用血流导向装置治疗较为安全有效。Objective To investigate the efficacy and safety of off-label use of flow diverters(FDs)in aneurysms beyond the circle of Willis.MethodsSeventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery,Neurosurgery Center(Zhujiang Hospital of Southern Medical University),Department of Neurosurgery(Guangdong Provincial People's Hospital),Department of Neurosurgery(First Affiliated Hospital of Chongqing Medical University),and Department of Neurosurgery(Beijing Tiantan Hospital,Capital Medical University)were selected.The clinical and imaging data of these patients were analyzed retrospectively,and the clinical characteristics,aneurysm characteristics,endovascular treatments,perioperative complications,and clinical and imaging follow-up results were summarized and analyzed.ResultsAmong the 71 patients,22(31.0%)had ischemic stroke history and 43(60.6%)had hypertension history.A total of 76 aneurysms were found,including 5 aneurysms(6.6%)at the anterior communicating artery,10(13.2%)at the anterior cerebral artery,53(69.7%)at the middle cerebral artery,and 8(10.5%)at the posterior cerebral artery.The median aneurysm size(Inter Quartile Range)was 5.65(3.63,10.12)mm,and mean diameter of the parent artery was(2.70±0.57)mm.A total of 80 FDs were used,including 38(47.5%)Pipeline embolization devices and 42(52.5%)Tubridge embolization devices;the implantation success rate was 98.8%(79/80).Seven patients(9.9%)had perioperative complications,of which 2(2.8%)were permanent(1 patient with visual field defect and 1 patient with intracranial hemorrhage).Seventy-one patients had clinical follow-up for(19.73±11.90)months,of which 68 patients(95.8%)had good outcome(modified Rankin scale score of 0-2),10 patients(14.1%)had ischemic complications,and one patient(1.4%)had hemorrhage complications.Sixty-seven aneurysms(88.2%)underwent angiographic follow-up for 7(6-12)months,of which 44 aneurysms(65.7%)were completely occluded and 10(14.9%)had

关 键 词：颅内动脉瘤 血流导向装置 远端动脉瘤 WILLIS环 

分 类 号：R651.12[医药卫生—外科学]