栓塞体积比在评价弹簧圈栓塞颅内动脉瘤疗效中的作用

Effect of volume embolization ratio in evaluating Guglielmi detachable coil embolization of intracranial aneurysms

目的探讨栓塞体积比（VER）在评价电解可脱性弹簧圈（GDC）栓塞颅内动脉瘤疗效中的作用。方法对在国内7家医院应用GDC栓塞、治疗期≥3年、直径〉2 mm的囊状动脉瘤患者,进行临床和影像学随访,共434例（446个动脉瘤）。根据填入动脉瘤内的弹簧圈体积与动脉瘤体积,计算动脉瘤VER。分析VER值与动脉瘤大小、瘤颈、栓塞结果、复发及再出血的关系。结果①小动脉瘤（〈5 mm）、中型动脉瘤（5-10 mm）、大动脉瘤（11-25 mm）、巨大动脉瘤（〉25 mm）的VER分别为（29±7）%、（24±7）%、（18±9）%和（8±7）%,不同大小动脉瘤患者之间的VER值差异有统计学意义（F=39.70,P〈0.01）;动脉瘤大小与VER值呈负相关（r=-0.50,P〈0.01）。窄、宽颈动脉瘤的VER值分别为（24±8）%、（20±9）%,差异有统计学意义（P=0.001）。②446个动脉瘤的VER为（24±8）%。动脉瘤完全栓塞、颈残留、体部残留患者的VER分别为（28±7）%、（23±7）%及（13±5）%,三者比较差异有统计学意义（F=150.71,P〈0.01）,且栓塞程度与VER值呈正相关（r=0.57,P〈0.01）。③术后临床随访〉3年,15个动脉瘤再出血,再出血者动脉瘤VER值为（16±9）%,无再出血者为（24±8）%,P〈0.01。④对357个动脉瘤进行DSA随访,中位随访期为16个月;动脉瘤保持稳定298个（83.5%）,VER为（25±8）%,复发59个（16.5%）,VER为（20±7）%,P〈0.01。⑤VER是动脉瘤术后再出血和复发的主要影响因素（OR：0.00,95%CI：0.00-0.08;OR：0.001,95%CI：0.00-0.03）。结论VER是评价动脉瘤栓塞程度的客观指标,对于栓塞术后动脉瘤的复发和再出血具有一定的预测意义。

Objective To investigate the effect of volume embolization ratio （VER） in evaluating the efficacy of Guglielmi detachable coil （GDC） embolization of intracranial aneurysms. Methods A total of 434 patients with 446 saccular aneurysms （ 〉 2 mm in diameter） were treated with GDC embolization in 7 Chinese hospitals for a period of≥3 years and were followed up clinically and radiologically. The volume embolization ratio （VER） of aneurysm was calculated according to the ratio of volume of coils placed in an aneurysm and the volume of the aneurysm. The relationship between the VER values and the results of aneurysm embolization, the size and the neck of aneurysm, recurrence, and rebleeding were analyzed. Results The VER of small （ 〈 5 mm）, medium （5 - 10 mm）, large （ 11 - 25 mm）, and giant （ 〉25 mm） aneurysms was （29±7）%, （24±7）%, （18±9）%, and （8±7）% respectively. The VER values had statistical significance between the patients with different sized aneurysms （ F = 39. 70, P 〈 0. 01 ）. The size of aneurysm was negatively correlated with the VER values （ r = - 0. 50, P 〈 0. 01 ）. The VER values of marrow-and wide-necked aneurysms were （ 24±8 ） % and （ 20±9 ） % respectively, and there was statistical significance （ P = 0. 001 ）. The VER of the 446 aneurysms was （24±8 ） %. The VER in patients with complete occlusion, neck residual and partial embolization of aneurysms were （28±7 ）% , （ 23±7 ） % and （ 13±5 ） % , respectively. There was statistical significance between them （ F = 150. 71, P 〈0. 01 ）, and the degree of embolization was positively correlated with the VER values. The patients were follow-up clinically for 〉 3 years after the procedures, and rebleeding occurred in 15 aneurysms. The aneurysmal VER in patients with and without rebleeding were （16±9 ）% and （24±8 ）%, respectively （P 〈0. 01 ）. DSA follow-up of 357 aneurysms were obtained, the mean follow-up period was 16 months; The aneurysms in 298 aneurysms （83.5%） remained stable, its VER was （25±8）%, and 59 patients （ 16. 5% ） had recurrence, its VER was （20±7 ） % （ P 〈0. 01 ）. VER was the main influencing factor of rebleeding and recurrence after aneurysm embolization （OR： 0.00, 95%CI： 0.00-0.08; OR： 0.01, 95% CI： 0. 00-0. 03）. Conclusion VER is an objective index in evaluating the embolization of aneurysms. It has certain predicting significance for recurrence and rebleeding after aneurysm embolization.