血管内介入治疗周围型颅内动脉瘤的疗效及其复发和预后不良的影响因素分析

Interventional treatment of peripheral intracranial aneurysms： short-term results and predictors of recurrence and unfavorable outcomes

目的探讨血管内介入治疗周围型颅内动脉瘤的效果并筛选其复发和预后不良的影响因素。方法南方医科大学珠江医院神经外科自2004年1月至2014年1月采用血管内介入治疗周围型颅内动脉瘤患者63例，其中43例行选择性弹簧圈栓塞，16例行载瘤动脉闭塞，4例行支架辅助弹簧圈栓塞。回顾性分析患者的临床资料和疗效。根据影像学随访结果判断动脉瘤是否复发，并将患者分为复发组和未复发组。根据临床随访结果将患者分为预后良好[改良Rankin量表评分（mRS）0～1分1组及预后不良（mRS评分2～6分）组。采用单因素和多因素Logistic回归分析方法分别分析动脉瘤复发和患者预后不良的影响因素。结果63例动脉瘤中完全栓塞50例，部分栓塞13例。患者影像学随访时间6～96个月，7例复发，均为夹层动脉瘤。患者临床随访时间6-100个月，预后良好52例，预后不良11例。复发组患者夹层动脉瘤比例、术后即刻部分栓塞比例高于未复发组（100％vs550％、57．1％vs516．1％），差异均有统计学意义（P〈0．05）。预后不良组患者高血压比例、Hunt—Hess分级Ⅲ～Ⅴ级比例、合并脑积水比例均高于预后良好组，差异均有统计学意义（P〈0．05）。Logistic回归分析显示合并脑积水为患者预后不良的独立危险因素。结论血管内介入治疗周围型颅内动脉瘤安全、有效。夹层动脉瘤及部分栓塞为动脉瘤复发的影响因素。合并脑积水为患者预后不良的独立危险因素。

Objective Peripheral intracranial aneurysms are rare lesions; the management of these lesions has been a challenge. Our present study is aimed to retrospectively evaluate the efficacy of endovascular treatments for peripheral intracranial aneurysms and explore the predictors of recurrence and unfavorable outcomes. Methods Sixty-three consecutive patients with peripheral intracranial aneurysms underwent endovascular treatment in our hospital from January 2004 to January 2014 were chosen in our study; 43 patients underwent selective coiling, 16 patients underwent parent artery occlusion, while 4 patients underwent stent-assisted coiling. Their clinical data and treatment efficacy were retrospectively reviewed. Imaging was performed to evaluate the recurrence. Follow-up outcomes were evaluated using modified Rankin scale, and the clinical outcomes of patients were categorized as favorable outcome （mRS score 0-1） or unfavorable outcome （mRS scores 2-6）. The predictors of recurrence and unfavorable outcomes were analyzed. Results Complete occlusion was achieved in 50 patients; partial occlusion was evident in 13 patients. Follow up for 6-96 months indicated 7 bad recurrence with dissecting aneurysms. Favorable outcomes were obtained in 52 of 63 patients. The recurrence patients had significantly higher percentages of dissecting aneurysms and immediately partial embolization than the patients without recurrence （100% vs. 50%, 57.1% vs. 16.1%, P〈0.05）. Patients with poor outcomes had significantly higher percentages of hypertension, Hunt-Hess grading Ⅲ-Ⅳ, and hydrocephalus than patients with good outcomes （P〈0.05）. Coexisting hydrocephalus was the independent predictor of unfavorable outcomes in the Logistic regression analysis. Conclusions Treating peripheral intracranial aneurysms via endovascular approach is safe and effective. Dissecting aneurysms and partial embolization are the influencing factors of recurrence; coexisting hydrocephalus is the independent predictor of unfavorable outcomes.