血流导向装置治疗颅内大型和巨大型动脉瘤的效果分析

Effect analysis of embolization device for the treatment of large or giant intracranial aneurysms

目的探讨Pipeline血流导向装置(PED)治疗颅内大型、巨大型动脉瘤的安全性及有效性。方法回顾性连续纳入2014年11月至2016年5月第二军医大学附属长海医院神经外科经DSA或头部CT血管成像(CTA)或头部MR血管成像(MRA)证实为颅内动脉瘤的患者33例,并对其临床及影像学资料进行分析,评价其安全性及有效性。结果 33例患者共35个动脉瘤,均成功释放PED,其中10个动脉瘤采用单纯PED置入,25个采用PED置入结合弹簧圈栓塞术(包含2个采用Pipeline桥接技术)。围手术期出现1例(1个动脉瘤)血栓栓塞事件并出血转化,1例(1个动脉瘤)因致死性动脉瘤延迟出血而死亡。临床随访31例(33个动脉瘤),随访时间为术后4~18个月,无出血或血栓栓塞事件发生。18个动脉瘤获术后短期影像学随访(3~5个月,增强MRA或DSA),其中10个瘤颈残留或瘤体显影,8个动脉瘤完全不显影;19个动脉瘤获术后中期影像学随访(6~16个月,增强MRA或DSA),其中2个瘤颈残留,17个动脉瘤完全不显影。结论 PED治疗颅内大型和巨大型动脉瘤安全有效,但血流导向装置置入后颅内出血的并发症不可忽视,其相关机制需进一步研究。

Objective To evaluate the safety and effectiveness of Pipeline embolization device（ PED） for the treatment of large and giant intracranial aneurysms.Methods From November 2014 to May 2016,the clinical and radiological data of 33 patients with intracranial aneurysm confirmed by DSA or head CT angiography（ CTA） or head magnetic resonance angiography（ MRA） at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively.Its safety and effectiveness were evaluated.Results The Pipelines were successfully released in 33 patients with 35 aneurysms,10 aneurysms were implanted by using PED alone,25 were implanted by using PED combined with coil embolization（ including 2 were implanted by using Pipeline bridging technology）.During the perioperative period,1 thrombotic event（ one aneurysm） occurred and had hemorrhagic transformation.One（ one aneurysm） died of fatal aneurysm delayed bleeding.Thirty-one patients（ 33 aneurysms） were followed up clinically,the follow-up time was 4-18 months,no bleeding or thrombosis events occurred.Eighteen aneurysms received a short-term postoperative imaging follow-up（ 3-5 months,enhanced MRA or DSA）,of which 10 had neck residue or aneurysm development,and 8 aneurysms did not have development at all,and 19 achieved postoperative mid-term imaging follow-up（ 6-16 months,enhanced MRA or DSA）.Two of them had neck residue and 17 did not develop at all.Conclusion Pipeline for the treatment of intracranial large and giant aneurysms may be safe and effective.However,the complications of intracranial hemorrhage cannot be ignored after implantation of embolization device.Its related mechanism needs to be further studied.