急性期球囊及支架辅助栓塞破裂型颅内动脉瘤

The therapeutic effect of balloon-assisted coiling and stent-assisted coiling of ruptured intracranial aneurysms in the acute phase

目的探讨在急性期球囊辅助与支架辅助栓塞颅内破裂动脉瘤的治疗效果。方法收集首都医科大学附属北京朝阳医院2014年1月至2016年12月,在急性期采用球囊或支架辅助技术栓塞的91枚破裂颅内动脉瘤患者资料。其中球囊辅助栓塞37例,支架辅助栓塞54例。采用回顾性分析的设计方法,用卡方分析比较两组患者的一般情况、动脉瘤的位置分布、形态、围手术期并发症及预后。结果球囊辅助栓塞组的动脉瘤颈宽度明显小于支架辅助栓塞组[(3.31±1.63)mm vs(4.35±2.10)mm,P=0.01)],球囊辅助栓塞瘤体/瘤颈的值低于支架辅助栓塞组[(1.64±0.46)vs.(1.35±0.66),P=0.025)];球囊辅助栓塞组复发率高于支架辅助栓塞组(18.9%vs.0.9%,P=0.005)。球囊辅助栓塞组与支架辅助栓塞组的围手术期并发症比较差异无统计学意义。支架辅助组术后有两例患者手术相关性颅内出血而死亡;患者术后6个月随访的改良Modified Rankin Score(mRS)评分(0~2分),球囊辅助栓塞组高于支架辅助栓塞组(94.6% vs.88.9%,P=0.028)。结论球囊辅助栓塞组与支架辅助栓塞组的围手术期并发症比较差异无统计学意义。球囊辅助栓塞的患者预后相对较好,但更易复发;而支架辅助栓塞适用于瘤颈更宽的动脉瘤。对于相对宽颈的急性期破裂动脉瘤,首先采用球囊辅助栓塞,再择期支架辅助栓塞,也是治疗选择之一。

Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC)and stent-assisted coiling (SAC)in patients with ruptured intracranial aneurysms in the acute phase.Methods Totally 91patients with 91intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014and December 2016.Among them,37patients were treated with BAC and 54patients with SAC respectively.Of the two groups,the position distribution and shape of aneurysms,and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test.Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs.4.35±2.10mm,P=0.01).The aneurysm body/neck ratio (B/N)was lower in the BAC-treated group than in the SAC-treated group (1.64±0.46vs.1.35±0.66,P=0.025).The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group(18.9%vs.0.9%,P=0.005).There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However,2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score,mRS,0-2)were achieved in the BAC-treated group compared to the SAC-treated group (94.6% vs.88.9%,P=0.028)at the follow-up visit.Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication.BAC can achieve a better prognosis,but it is more prone to relapse.The SAC method was more appropriate for wider neck aneurysms.It was also an option to coiling the aneurysm in BAC in acute phase firstly,followed by additional treatment in SAC during the follow-up period.