不同支架辅助栓塞颅内动脉瘤的比较研究

A comparative study of different stent assisted embolization of intracranial aneurysms

目的比较不同颅内支架辅助弹簧圈栓塞颅内动脉瘤的安全性和有效性，探讨3种不同颅内支架在辅助动脉瘤栓塞选择中的作用。方法回顾性分析2007年4月至2012年4月行颅内支架辅助栓塞的118例患者（共128个宽颈动脉瘤）的临床资料，男28例、女90例；年龄25～86岁，平均（57±18）岁。对术中是否使用成功、术后即刻造影动脉瘤闭塞以及早期围手术期并发症等情况进行比较分析，观察不同支架治疗的安全性和有效性。统计学分析采用秩和检验和）（。检验。结果共成功植入128个支架，其中Neuroform支架70个，Enterprise支架38个和SolitaireAB支架20个。有3例植入Neuroform支架失败后采用Enterprise支架成功。术后即刻造影动脉瘤栓塞结果：Neuroform支架致密栓塞率为40．0％（28／70），瘤体残留率38．6％（27／70），部分栓塞率21．4％（15／70）；Enterprise支架致密栓塞率为42．1％（16／38），瘤体残留率36．8％（14／38），部分栓塞率21．1％（8／38）；SolitaireAB支架致密栓塞率为40．0％（8／20），瘤体残留率35．0％（7／20），部分栓塞率25．0％（5／20）；3种支架在栓塞效果上差异无统计学意义（H=0．12，P〉0．05）。早期围手术期并发症的发生结果：Neuroform支架发生7个，Enterprise支架发生4个，SolitaireAB支架发生2个，3种支架总并发症的发生差异无统计学意义（χ2=0，P〉0．05）。结论3种颅内支架辅助弹簧圈栓塞动脉瘤是安全有效的，应根据载瘤动脉形态及其支架生物性能，合理选择支架类型。

Objective To compare the effectiveness and safety of different intracranial stents assisted coil embolization of intracranial aneurysms and to discuss the selection of different stent assisted embolization of intracranial aneurysm. Methods From 2007 April to 2012 April, 118 cases （a total of 128 wide-neck aneurysms） with intracranial aneurysms were analyzed retrospectively. This included the use of 70 neuroform, 38 Enterprise, and 20 Solitaire AB stents for the treatment of intraeranial aneurysms. The successful use, aneurysm occlusion at the immediate post-operation, and early period of peri-operative complications were recorded from those clinical data in order to assess the effectiveness and safety of the 2 different intracranial stents, which assisted coil embolization of intracranial aneurysms. Rank sum test and χ2 test were used for statistics. Results Three aneurysms assisted with Neuroform stent were planted unsuccessfully, and the Enterprise and Solitaire stents were placed successfully. The embolism results of three stents after immediate postoperative angiography aneurysm ： Neuroform stent occlusion rate was 40.0% （ 28/ 70） ,the tumor residual rate was 38.6 % （27/70） ,and the partial embolization rate was 21.4 % （15/70） ; The Enterprise stent occlusion rate was 42. 1% （ 16/38 ） , the tumor residual rate was 36. 8 % （ 14/38 ） , and the partial embolization rate was 21.1% （8/38）. The Solitaire AB stent occlusion rate was 40.0 % （8/20）, the tumor residual rate was 35.0 % （ 7/20 ）, and the partial embolization rate was 25.0 % （ 5/20 ）. There were not significant differences in aneurismal occlusion （H = 0. 12, P 〉 0. 05 ）. Early peri-operative complications results were ： Neuroform stent occurred in 7, Enterprise frame in 4, and Solitaire AB stent occurred in 2. There were no significant differences in the incidence of complications in the early period after coiling （ χ2 = 0, P 〉 0. 05 ）. Conclusions Three kinds of intracranial stents assisted embolization of intracranial aneurysms are applied s.afely and effectively. The stent may be chosen according to morphology ofparent artery and stent biological character.