瘤内扰流装置治疗颅内宽颈动脉瘤的多中心回顾性研究  

Efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms: a multicenter retrospective study

作　　者：张笑闻 李菁[1] 李西锋[2] 段传志[2] 刘爱华[3] 史怀璋[4] 徐浩文[1] 马南[1] 姚智强 范锋[1] 刘朝[1] 李进一[1] 钟海龙 范梦妍 万佳鑫 林日金 刘惠翔 张佳镁 张炘[2] 管生[1] Zhang Xiaowen;Li Jing;Li Xifeng;Duan Chuanzhi;Liu Aihua;Shi Huaizhang;Xu Haowen;Ma Nan;Yao Zhiqiang;Fan Feng;Liu Chao;Li Jinyi;Zhong Hailong;Fan Mengyan;Wan Jiaxin;Lin Rijin;Liu Huixiang;Zhang Jiamei;Zhang Xin;Guan Sheng(Department of Neurointervention,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;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,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]郑州大学第一附属医院神经介入科,郑州450052 [2]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 [3]首都医科大学附属北京天坛医院神经外科,北京100070 [4]哈尔滨医科大学第一附属医院神经外科,哈尔滨150001

出　　处：《中华神经医学杂志》2025年第1期16-22,共7页Chinese Journal of Neuromedicine

基　　金：河南省高等学校重点科研项目(24A320026)。

摘　　要：目的评估瘤内扰流装置治疗颅内宽颈动脉瘤的有效性及安全性。方法选择自2022年8月至2024年3月在郑州大学第一附属医院神经介入科、首都医科大学附属北京天坛医院神经外科、南方医科大学珠江医院神经外科中心脑血管病外科和哈尔滨医科大学第一附属医院神经外科接受瘤内扰流装置治疗的117例颅内宽颈动脉瘤患者为研究对象。所有患者术后即刻采用Raymond-Roy分级评估动脉瘤的闭塞情况;术后48 h内行头颅CT或MRI检查,明确有无新发颅内出血、蛛网膜下腔出血或与颅内动脉瘤部位相关的症状性脑梗死;出院时采用改良Rankin量表(mRS)评估神经系统功能情况;术后6个月时进行影像学及门诊随访,评估动脉瘤闭塞程度及并发症发生情况。结果117例患者共置入117个瘤内扰流装置,技术成功率为100%,其中115个(98.3%)术中一次性释放成功,2个(1.7%)术中经过回收、调整方向后二次释放成功。另有13例(11.1%)患者采用瘤内扰流装置联合支架辅助治疗。患者术后即刻Raymond-Roy分级Ⅰ级3例,Ⅱ级51例,Ⅲ级63例;术后48 h内均未见新发颅内出血、蛛网膜下腔出血及与颅内动脉瘤部位相关的症状性脑梗死;出院时mRS评分均为0分。83例患者完成术后6个月的影像学及门诊随访,其中Raymond-Roy分级Ⅰ级41例、Ⅱ级33例、Ⅲ级9例,且均无缺血性及出血性不良事件发生。结论本研究结果初步提示瘤内扰流装置治疗颅内宽颈动脉瘤的有效性及安全性均较好。Objective To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.MethodsOne hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention(First Affiliated Hospital of Zhengzhou University),Department of Neurosurgery(Beijing Tiantan Hospital,Capital Medical University),Department of Cerebrovascular Surgery,Neurosurgery Center(Zhujiang Hospital,Southern Medical University),and Department of Neurosurgery(First Affiliated Hospital of Harbin Medical University)from August 2022 to March 2024.Raymond-Roy Occlusion Classification(RROC)was employed to evaluate aneurysm embolization immediately after procedure;cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage,subarachnoid hemorrhage,or new symptomatic cerebral infarction related to the intracranial aneurysms.Modified Rankin Scale(mRS)was used to assess the neurological function at discharge.Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.ResultsA total of 117 intrasaccular flow disruptors were implanted in 117 patients,with a technical success rate of 100%;115 patients(98.3%)enjoyed successful one-time release of their disruptors,and 2 patients(1.7%)required retrieval and redirection of the disruptors before second successful attempt.Flow disruptor plus stent was performed in 13 patients(11.1%).Immediately after procedure,RROC grading I was noted in 3 patients,grading II in 51 patients and grading III in 63 patients.Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage,subarachnoid hemorrhage,or symptomatic cerebral infarction related to the intracranial aneurysms.All patients had mRS score of 0 at discharge.Eighty-three patients completed a 6-month follow-up(RROC grading I in 41 patients,grading II in 33 patients and grading II

关 键 词：颅内动脉瘤 宽颈动脉瘤 瘤内扰流装置 

分 类 号：R651.12[医药卫生—外科学]