第三代血流导向装置治疗颅内动脉瘤临床效果的初步研究  

Preliminary study on the effect of the third generation flow diverter device in the treatment of intracranial aneurysms

作　　者：尹晓亮 杨军 王涛 陈晓东 刘鹏 王大明[2] Yin Xiaoliang;Yang Jun;Wang Tao;Chen Xiaodong;Liu Peng;Wang Daming(Department of Neurosurgery,Peking University Third Hospital,Center for Precision Neurosurgery and Tumor Research,Peking University Health Science Center,Beijing 100191,China;Department of Neurosurgery,Beijing Hospital,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京大学第三医院神经外科、北京大学医学部精准神经外科与肿瘤研究中心,北京100191 [2]北京医院神经外科国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华外科杂志》2025年第3期233-239,共7页Chinese Journal of Surgery

摘　　要：目的探讨第三代血流导向装置治疗颅内动脉瘤的初步临床效果。方法本研究为回顾性病例系列研究。回顾性分析2023年3月至2024年2月于北京大学第三医院神经外科应用第三代血流导向装置治疗的38例颅内动脉瘤患者的临床资料。男性11例,女性27例,年龄(58.6±12.9)岁(范围:27~82岁)。所有患者术后即刻行数字减影血管造影(DSA)检查,观察支架位置、贴壁情况,采用O′Kelly-Marotta(OKM)分级系统评估动脉瘤栓塞程度,以动脉瘤OKM分级D级为完全闭塞;并记录围术期出血性及缺血性脑卒中发生情况。患者出院时采用改良Rankin量表(mRS)评估患者神经功能状况。术后6~12个月复查CT血管造影、DSA,评价支架位置、动脉瘤栓塞情况。结果38例患者(39个动脉瘤)共使用40枚血流导向装置,6个动脉瘤联合弹簧圈栓塞。围手术期无缺血性及出血性脑卒中发生。所有患者出院时mRS评分为0分。所有患者均获得随访,随访时间(9.0±3.8)个月(范围:6.0~16.4个月),1例右侧颈内动脉眼动脉段动脉瘤患者出现发作性右眼单眼黑矇症状。38例患者术后6个月均复查DSA,动脉瘤完全闭塞率为89.7%(35/39)。12个月随访时31例患者完成DSA复查,动脉瘤完全闭塞率为96.8%(30/31)。结论初步研究结果显示,第三代血流导向装置治疗颅内动脉瘤并发症发生率低,动脉瘤闭塞率高,是临床可选的治疗方法。ObjectiveTo investigate the clinical effect of the third diverter device in the treatment of intracranial aneurysms.MethodsThis is a retrospective case series study.A retrospective study was conducted on patients with intracranial aneurysms treated with the new flow-diverting device at the Department of Neurosurgery,Peking University Third Hospital from March 2023 to February 2024.There were 11 males and 27 females,aged(58.6±12.9)years(range:27 to 82 years).All patients underwent digital subtraction angiography(DSA)at the time of surgery to observe the stent position,wall apposition.The degree of aneurysm embolization was evaluated using the O′Kelly-Marotta(OKM)grading system,with OKM grade D as complete occlusion.The incidence of perioperative intracranial hemorrhagic and ischemic complications was recorded.The modified Rankin scale(mRS)was used to assess patients′neurological function at discharge.CT angiography and DSA were performed 6 to 12 months postoperatively to evaluate the stent position and aneurysm embolization.ResultsA total of 38 patients with 39 intracranial aneurysms were treated using 40 stents,with coil embolization applied to 6 aneurysms.No ischemic or hemorrhagic events occurred during the perioperative period.At discharge,all patients had an mRS score of 0.During follow-up,one patient with an ophthalmic artery segment aneurysm experienced transient monocular blindness.Imaging follow-up by DSA showed that the complete aneurysm occlusion rate was 89.7%(35/39)at 6 months and 96.8%(30/31)at 12 months.ConclusionThe flow-diverting device demonstrates a low complication rate and a high aneurysm occlusion rate,which is a clinically optional treatment approach.

关 键 词：颅内动脉瘤 神经外科手术 血流导向装置 Pipeline Shield栓塞装置 并发症 

分 类 号：R74[医药卫生—神经病学与精神病学]