血流导向装置Pipeline治疗颅内动脉瘤的近期疗效

Short-term outcome following treatment of intracranial aneurysms with pipeline embolization device

目的探讨Pipeline栓塞装置（PED）治疗颅内动脉瘤的初步疗效和安全性。方法南方医科大学珠江医院神经外科自2016年2月至6月应用PED治疗6例颈内动脉瘤患者，现回顾性分析患者的临床资料及近期疗效。结果本组患者共6个动脉瘤，均成功置入PED。共置入8枚PED，平均1.3枚；置入3枚者1例，1枚者5例；单纯置入PED3例，联合弹簧圈栓塞3例。置入PED后，即刻造影显示瘤腔内造影剂滞留，Kamran分级I级4例、Ⅱ级2例。出院时患者改良Rankin量表（mRS）评分0分2例，1分3例，3分1例。临床随访所有患者均未见并发症发生，5例患者术后3个月行MRA随访均未见动脉瘤残留影且远端血管通畅，其中1例行数字减影全脑血管造影（DSA）检查未见动脉瘤复发。结论PED治疗颅内动脉瘤安全可行，近期疗效满意，远期疗效仍需要大规模临床试验和长期随访结果进一步评价。

Objective To present our preliminary experience and short-term safety and efficacy of pipeline embolization device （PED） for endovascular of intracranial aneurysms. Methods Six patients treated with PED in our hospital from February 2016 to June 2016 were chosen. Their clinical data and short-term safety and efficacy were retrospectively analyzed. Results Six patients with 6 intracranial aneurysms were treated during the study period. Mean aneurysm size was 18.3±9.2 mm. PED was technically successful in all aneurysms （100%）. A total of 8 PEDs were used, and the mean number of devices per aneurysm was 1.3. Treatment was achieved with one single PED in 5 aneurysms, with 3 overlapping PEDs in one aneurysm. Adjunctive coiling was performed in 3 aneurysms. Retention of contrast agent in the tumor cavity was detected by immediate radiography： Kamran grade I was noted in 4 patients and grade II in 2 patients. No procedure-related complications occurred. Five patients achieved good clinical outcome （mRS score 0 in 2 patients, one in 3 patients and 3 in one patient）. MRA was performed in 5 patients 3 months after surgery, indicating no arterial aneurysm residual and far-endvascular patency; and one of these 5 patients was performed DSA showing no arterial aneurysm relapse. Conclusions In our series, early results of the PED are encouraging. However, larger studies with longer follow-up duration are warranted to assess the safety and efficacy of PED for treating intracranial aneurysms.