Pipeline血流导向装置治疗中小型颅内动脉瘤的安全性及有效性分析  

Analysis of the safety and efficacy of Pipeline embolization device in the treatment of small and medium-sized intracranial aneurysms

作　　者：李明洲[1] 康慧斌 谢采铃 温运宇 李鹏[1] 张世超[1] 王刚[1] 张国忠[1] 冯文峰[1] Li Mingzhou;Kang Huibin;Xie Cailing;Wen Yunyu;Li Peng;Zhang Shichao;Wang Gang;Zhang Guozhong;Feng Wenfeng(Department of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2025年第3期262-267,共6页Chinese Journal of Neurosurgery

基　　金：南方医院院长基金(2023A037)。

摘　　要：目的探讨Pipeline血流导向装置(PED)治疗中小型颅内动脉瘤(动脉瘤最大径≤10 mm)的安全性及有效性。方法回顾性收集2018年1月至2021年12月南方医科大学南方医院神经外科采用PED治疗的90例中小型颅内动脉瘤患者的临床及影像学资料。术后6、12、24个月对患者进行临床及数字减影血管造影(DSA)随访,采用O′Kelly-Marotta(OKM)分级评估动脉瘤的闭塞程度,采用改良Rankin量表(mRS)评分评估患者预后,其中mRS评分0~2分为预后良好。结果90例患者(108个动脉瘤)共置入90枚PED,均顺利完成。5例(5.6%)患者发生围手术期并发症,其中术后脑梗死4例,迟发性脑实质出血1例;术后支架内血栓形成1例,经溶栓治疗后管腔通畅;无一例患者发生术中或术后迟发性动脉瘤破裂或死亡。90例患者均获得临床随访,随访时间[M(Q_(1),Q_(3))]为11.0(5.0,13.0)个月;末次随访显示,预后良好率为92.2%(83/90)。79例患者(94个动脉瘤)获得DSA随访,随访时间[M(Q_(1),Q_(3))]为14.9(12.0,16.0)个月;末次随访显示,动脉瘤OKM分级A级1个(1.1%),B级5个(5.3%),C级10个(10.6%),D级78个(83.0%)。1例(1.3%)患者发生支架内狭窄,5例(6.3%)发生眼动脉分支狭窄或闭塞,2例(2.5%)发生支架外载瘤动脉近端狭窄,但均未出现明显临床症状。结论PED治疗中小型颅内动脉瘤安全、有效,且并发症发生率较低。ObjectiveTo explore the safety and efficacy of the Pipeline embolization device(PED)in the treatment of small and medium-sized intracranial aneurysms(with the maximum diameter of the aneurysm≤10 mm).MethodsThe clinical and imaging data of 90 patients with small and medium-sized intracranial aneurysms treated with PED at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University from January 2018 to December 2021 were retrospectively collected.Clinical and digital subtraction angiography(DSA)follow-up was carried out on the patients at 6,12,and 24 months post operation.The O′Kelly-Marotta(OKM)grading system was used to evaluate the degree of aneurysm occlusion,and the modified Rankin Scale(mRS)score was used to evaluate the outcomes of the patients.The mRS score of 0-2 was considered a good outcome.ResultsAll 90 patients(108 aneurysms)successfully completed the PED treatment and a total of 90 PEDs were implanted.Peri-operative complications occurred in 5 patients(5.6%),including 4 cases of postoperative cerebral infarction,1 case of delayed intracerebral hemorrhage,and 1 case of in-stent thrombosis.The lumen became unobstructed after thrombolytic treatment.No intraoperative,postoperative delayed aneurysm rupture or patient death occurred.All 90 patients were followed up clinically,with a follow-up time period of 11.0(5.0,13.0)[M(Q_(1),Q_(3))]months.The last follow-up showed that the rate of good outcome was 92.2%(83/90).A total of 79 patients(94 aneurysms)were followed up by DSA,with a follow-up time period of 14.9(12.0,16.0)[M(Q_(1),Q_(3))]months.The last follow-up showed that according to the OKM grading system of arterial aneurysm,there was 1 case(1.1%)of grade A,5 cases(5.3%)of grade B,10 cases(10.6%)of grade C,and 78 cases(83.0%)of grade D.In-stent stenosis occurred in 1 patient(1.3%),stenosis or occlusion of the ophthalmic artery branches occurred in 5 patients(6.3%),and proximal stenosis of the parent artery outside the stent occurred in 2 patients(2.5%),while no obvious clinical sympto

关 键 词：颅内动脉瘤 血管内操作 治疗结果 手术后并发症 Pipeline血流导向装置 

分 类 号：R651.1[医药卫生—外科学]