腔内置入血流导向装置治疗颈内动脉颅内段动脉瘤的短期疗效

Short-term follow up of pipeline embolization device （PED） deployment for treatment of intracranial carotid aneurysm

目的探讨观察腔内置入血流导向装置（PED）治疗复杂颈内动脉动脉瘤的技术特点和短期疗效。方法回顾性分析2015年1至6月在河南省人民医院介入治疗中心行腔内治疗的6例颈内动脉颅内段动脉瘤患者的临床资料，其中男2例、女4例；年龄34～70岁，平均（56±13）岁。6例患者均在全身麻醉下通过股动脉入路于载瘤动脉置入PED覆盖动脉瘤颈，围手术期给予双抗血小板处理。记录患者基本资料及围手术期不良事件。术后1个月进行临床随访并采用改良Rankin评分评估，术后3个月进行影像学随访，并对动脉瘤栓塞情况进行Raymond分级。结果6例均为未破裂动脉瘤，PED置入手术均获技术成功。其中3例为单独PED置入，3例为PED置入加弹簧圈栓塞；6例患者围手术期均无操作相关并发症，且末次随访均具有较好预后（mRS评分〈2分）。随访时间1．5～4．8个月，中位随访2．8个月；术后即刻造影显示动脉瘤瘤体仍然显影（Raymond分级均为3级），但术后3个月造影复查2例，显示动脉瘤获有效闭塞（Raymond分级≤2级）。结论PED置入治疗复杂颈内动脉动脉瘤安全可行，短期随访有效。

Objective To explore the technical skills and short-term efficacy of Pipeline Embolization Device （PED） deployment for endovascular treatment of complex intracranial carotid aneurysm. Methods The medical charts of 6 cases who underwent PED implant procedure in our institute from Jan. to Jun. 2015 were reviewed, including 4 female and 2 male; the mean age was （56± 13） years, ranging from 34-70 years. All the 6 cases suffered from intracranial carotid aneurysm and PED implant procedures were performed to cover the aneurismal neck under general anesthesia, while dual antiplatelet treatment （Bayaspirin ＋ Plavix） was administered. The basic characteristics and peri-procedural adverse events were recorded, interview and mRS score were done by telephone 1 month after procedure, clinical examination and DSA angiographic re-check were made 3 months following procedure, respectively. Status of aneurysm occlusion was evaluated by Raymond grading scale. Results All 6 aneurysms involved were unruptured. Technical success was achieved in all procedures for 6 cases, of which 3 cases were single PED implantation and the other 3 PED adjuncted to coiling. No procedure related complication was detected during 30 days after operation. Follow up with 1.5-4.8 months （median 2.8 months） were conducted and last follow up revealed good outcome （mRS〈2） in all cases. The control angiography showed contrast filling aneurismal sac even after PED implantation, DSA recheck performed in 2 cases at 3 months after operation and revealed good obstruction of aneurysm （Raymond grade≤2）. Conclusion Domestic preliminary study shows PED implantation seems to be a safe and effective modality for treatment of complex intracranial carotid aneurysms.