后交通动脉动脉瘤血管内栓塞术后复发的影响因素分析

Analysis of influencing factors of recrudescence after endovascular embolization of posterior communicating artery aneurysms

目的探讨影响后交通动脉动脉瘤血管内栓塞术后复发的危险因素。方法回顾性连续纳入2014年1月至12月皖南医学院附属弋矶山医院神经外科接受血管内治疗的后交通动脉动脉瘤患者71例(共74个动脉瘤),以动脉瘤数计为例数(74例)。根据动脉瘤是否复发,分为复发组(18例)和未复发组(56例)。比较两组临床资料及动脉瘤特征的差异,采用Logistic多因素回归分析后交通动脉动脉瘤血管内栓塞术后复发的危险因素。结果 74例动脉瘤中,单纯弹簧圈栓塞51例,使用支架辅助栓塞23例,均释放满意。两组患者动脉瘤大小、Raymond分级的组间差异均有统计学意义(均P<0.01);复发组合并子囊发生率[55.6%(10/18)]、非支架辅助比例[88.9%(16/18)]均高于未复发组[23.2%(13/56)、62.5%(35/56)],组间差异均有统计学意义(均P<0.05);其余动脉瘤特征的组间差异均无统计学意义(均P>0.05)。经变量筛选,Raymond分级以RaymondⅠ级为参照,进行多因素Logistic回归分析显示,非支架辅助(OR=4.789,95%CI:1.207~19.009,P=0.026)、RaymondⅡ级(OR=12.326,95%CI:3.838~39.592,P<0.01)、RaymondⅢ级(OR=36.884,95%CI:2.892~470.454,P=0.005)是后交通动脉动脉瘤栓塞术后复发的独立危险因素。结论非支架辅助、RaymondⅡ~Ⅲ级可能会引起后交通动脉动脉瘤术后复发。

Objective To investigate the risk factors for influencing recrudescence after endovascular embolization of posterior communicating artery aneurysms.Methods From January 2014 to December 2014,71 consecutive patients （a total of 74 aneurysms） with posterior communicating artery aneurysm treated with endovascular treatment at the Department of Neurosurgery,Yijishan Hosptial of Wannan Medical College were enrolled retrospectively.The aneurysms were calculated as the number of cases （n=74）.The aneurysms were divided into two groups according to whether they had recrudescence or not,including recurrent group （n=18） and non-recurrent group （n=56）.The differences of the clinical data and aneurysm characteristics between the two groups were compared.Multivariate logistic regression was used to analyze the risk factors for recrudescence after endovascular embolization of posterior communicating artery aneurysms.Results Of the 74 patients with aneurysm,51 were treated with simple coil embolization and 23 were treated with stent-assisted coil embolization.All the coils were released satisfactorily.There were significant difference in the size of aneurysms and Raymond grade between the two groups （all P〈0.01）.The incidence of aneurysms with daughter cysts （55.6% [10/18] and the rate of non-stent-assisted coil embolization （88.9% [16/18]） in the recurrent group were significantly higher than those in the non-recurrent group （23.2% [13/56],62.5% [35/56]）.The difference between the two groups was statistically significant （all P〈0.05）.There was no significant difference in other aneurysm features between the two groups （all P〉0.05）.After variable selection,the Raymond grade was referred to Raymond gradeⅠ.Multivariate logistic regression analysis showed that the non-stent-assisted coil embolization （OR,4.789,95%CI 1.207-19.009,P=0.026）,Raymond grade Ⅱ （OR,12.326,95%CI 3.838-39.592,P〈0.01）,Raymond grade Ⅲ （OR,36.884,95%CI 2.892-470.454,P=0.005） were the independent risk factors for recrudescence after embolization of posterior communicating artery aneurysms.Conclusion Non-stent-assisted coil embolization,Raymond Ⅱ and Ⅲ may cause recrudescence of posterior communicating artery aneurysms.