Pipeline栓塞装置治疗未破裂颅内段椎动脉夹层动脉瘤:18例病例系列研究  

Pipeline embolization device for the treatment of unruptured intracranial vertebral artery dissecting aneurysms:a case-series study of 18 patients

作　　者：赵常发 张西安 刘展会 张睿 豆涛涛 Zhao Changfa;Zhang Xi'an;Liu Zhanhui;Zhang Rui;Dou Taotao(Department of Neurosurgery,Xi'an Ninth Hospital,Xi'an 710000,China)

机构地区：[1]西安市第九医院神经外科,西安710000

出　　处：《国际脑血管病杂志》2024年第9期681-686,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的初步探讨Pipeline血流栓塞装置(Pipeline embolization device,PED)治疗颅内段未破裂椎动脉夹层动脉瘤(vertebral artery dissecting aneurysm,VADA)的安全性和有效性。方法回顾性纳入2015年12月至2023年9月在西安市第九医院神经外科接受PED治疗的未破裂颅内VADA患者。收集人口统计学、血管危险因素、临床症状、术前改良Rankin量表(modified Rankin Scale,mRS)评分、影像学资料以及治疗方案等资料。采用O’Kelly-Marotta(OKM)分级标准评估动脉瘤闭塞。结果共纳入18例未破裂颅内VADA患者,男性12例(66.7%),年龄37~67岁。所有患者均成功完成PED置入,且均未发生围操作期并发症。6例(33.3%)使用弹簧圈辅助栓塞,12例(66.7%)为单纯置入PED。10例(55.6%)术后即刻数字减影血管造影(digital subtraction angiography,DSA)显示动脉瘤腔内有对比剂滞留。18例获得临床随访,其中mRS评分0分12例(66.7%),1分6例(33.3%)。15例(88.3%)接受了DSA随访,其中OKM分级D级12例(80.0%),C级3例(20.0%),小脑后下动脉均血流通畅。结论使用PED治疗未破裂颅内VADA是安全有效的。Objective To preliminarily investigate the safety and efficacy of Pipeline embolization device(PED)in the treatment of unruptured intracranial vertebral artery dissecting aneurysm(VADA).Methods Patients with unruptured intracranial VADA received PED treatment in the Department of Neurosurgery,Xi'an Ninth Hospital from December 2015 to September 2023 were included retrospectively.Their demographic data,vascular risk factors,clinical symptoms,preoperative modified Rankin Scale(mRS)scores,imaging data,and treatment regime were collected.The O'Kelly-Marotta(OKM)grading scale was used to evaluate the occlusion of aneurysms.Results A total of 18 patients with unruptured intracranial VADA were enrolled,including 12 males(66.7%),aged 37-67 years.All patients successfully completed PED implantation without any periprocedural complications.Six patients(33.3%)were treated with coil-assisted embolization,and 12(66.7%)were treated with PED implantation alone.Digital subtraction angiography(DSA)showed contrast retention in aneurysm lumen in 10 patients(55.6%)immediately after surgery.Clinical follow-up was performed in 18 patients,of which the mRS score was 0 in 12 patients(66.7%)and the mRS score was 1 in 6 patients(33.3%).Fifteen patients(88.3%)received DSA follow-up,including 12(80.0%)with OKM grade D and 3(20.0%)with grade C,and the posterior inferior cerebellar arteries had smooth blood flow.Conclusion PED is safe and effective in the treatment of unruptured intracranial VADA.

关 键 词：颅内动脉瘤 椎动脉 椎动脉夹层 血管内手术 栓塞 治疗性 支架 治疗结果 

分 类 号：R651.12[医药卫生—外科学]