第一代Matrix弹簧圈治疗颅内动脉瘤的安全性及中长期随访结果分析

Middle and long-term follow-up of intracranial aneurysms treated with Matrix detachable coils

目的分析第一代Matrix可吸收聚合物涂层弹簧圈(简称Matrix)治疗颅内动脉瘤的安全性,及中、长期随访结果的影响因素。方法回顾性研究,本中心2003年5月至2005年7月75例使用Matrix栓塞颅内动脉瘤患者(79枚动脉瘤)。其中造影复查患者34例(35枚动脉瘤),平均随访时间12.5个月。根据复查结果对年龄、性别、动脉瘤最大径、瘤颈宽度、使用支架辅助、Matrix长度比例进行COX模型分析。结果Matrix相关的手术并发症率为13.3%,使用Matrix术后动脉瘤总复发率为11.4%,辅助支架治疗的大型动脉瘤的复发率为40%,未致密栓塞的动脉瘤中61.1%发生进一步栓塞。无统计学结果可证明年龄、性别、动脉瘤最大径、瘤颈宽度、支架辅助、Matrix占栓塞弹簧圈长度比例等因素影响Matrix栓塞动脉瘤的中长期预后。结论Matrix治疗颅内动脉瘤安全、有效,结合支架辅助技术可能会降低大型动脉瘤的复发率。Matrix弹簧圈有促进动脉瘤愈合的倾向,建议尽可能改善动脉瘤的血流动力学状况,此举将有利于动脉瘤长期愈后。Matrix弹簧圈的长期确切效果有待进一步随访观察及进行大样本的随机对照研究。

Objective This study was undertaken to evaluate the safety of the polyglycolic/polylactic acid （PGLA）-coated Matrix detachable coils （Matrix） and analyze factors which may relate to the recanalization rate of the Matrix coils in the treatment of intracranial aneurysms. Methods 75 patients underwent 79 aneurysm treatments with Matrix coils from May 2003 to July 2005 were retrospectively investigated. Morphological changes were compared postoperatively with last-follow-up digital subtraction angiography （DSA） by using the Raymond scale. We defined incomplete recanalization or stable aneurysms as uncured , while those of progressive occlusion or complete occlusion aneurysms demonstrated on the last-follow-up imagings as cured. We also utilized Cox model for analyzing the relationships between factors including age, gender, degree of aneurysmal occlusion, stenting, aneurysm neck size, aneurysm maximum size and Matrix coils length（%） and the long-term angiographic follow-up results. Results The correlative surgical complications rate with Matrix coils was 13.3%. The total rate of recanalization was 11.4%. Large aneurysms treated with combined stenting got 40% recanalization. No statistic relationships were shown between the factors forementioned and the recanalization rate, but progressive occlusion was observed in 11 （61%）incompletely treated aneurysms. Conclusions Matrix detachable coil technique is safe for intracranial aneurysm and would further decrease the recurrence of large aneurysm with combination of stenting but long term efficacy needs further follow-up and large scale randomized control study.