血管内栓塞治疗颅内未破裂动脉瘤的临床分析

Clinical analysis of endovascular embolization of unruptured intracranial aneurysms

目的 探讨血管内栓塞治疗颅内未破裂动脉瘤的有效性和安全性.方法 回顾性分析2011年1月至2016年12月南方医科大学珠江医院神经外科收治的256例颅内未破裂动脉瘤患者（共333个动脉瘤）的临床资料.所有病例均行血管内栓塞治疗,总结手术结果和并发症,并采用改良Rankin量表评分（mRS）评估患者的预后.结果 动脉瘤的完全栓塞率为88.7％ （227/256）,发生不良临床结果24例（9.4％）,其中手术相关并发症9例（3.5％）.该9例患者中,发生出血3例（1.2％）,其中1例（0.4％）出现永久性的神经功能障碍.术后出现头痛86例（33.6％）,且多见于支架辅助栓塞术后（P =0.004）.随访时间为3～49个月,平均（18.6±1.5）个月.256例患者中,随访期内发生支架内狭窄6例（2.3％）,动脉瘤复发10例（3.9％）,无死亡病例.95.7％的患者预后良好（mRS＜2分）.对于巨大型颅内未破裂动脉瘤（直径＞25 mm）,行血管内治疗易发生不良结果（P=0.045）;直径＞10 mm的颅内未破裂动脉瘤行血管内治疗后易出现动脉瘤复发（P =0.004）.结论 血管内栓塞治疗颅内未破裂动脉瘤是一种安全、有效的治疗方法,选择合适的病例进行干预,能够减少出血风险,获得良好的预后.

Objective To explore the efficacy and safety of endovascular embolization of unruptured intracranial aneurysms （UIA）.Methods We retrospectively analyzed the clinical outcomes and complications of 256 patients with UIA who underwent endovascular embolization at Department of Neurosurgery,Zhujiang Hospital,Southern Medical University from January 2011 to December 2016.The clinical prognosis was further evaluated by using modified Rankin Scale （mRS）.Results In 256 patients （333 aneurysms）,the percentage of complete occlusion after endovascular procedures was 88.7% （227/256）.Poor clinical outcomes were reported in 24 （9.4%） cases.Surgery-related complications occurred in 9 （3.5%） cases,out of which 3 （1.2%） showed hemorrhage and permanent neurological deficit was observed in 1 case（0.4%）.Associated headaches following endovascular treatment occurred in 86 patients （33.6%）,and were more commonly observed in cases undergoing stent assisted embolization of UIA （P =0.04）.The mean follow-up time was 18.6 ± 1.5 months and ranged from 3 to 49 months.During the follow-up period,stent stenosis oecttrred in 6 patients （2.3%）,10 patients （3.9%） developed recurrence of aneurysm,and no case died.Finally,favorable clinical prognosis （mRS 〈2） was achieved in 95.7% of the patients.Patients with giant aneurysms （diameter over 25 mm） were more likely to achieve poor outcomes （P =0.045）,and the diameter of UIA over 10 mm （P =0.004） was correlated with aneurysm recurrence after endovascular treatment.Conclusions Endovascular embolization is suggested to be a safe and efficacious way to treat UIA.Proper selection of surgical candidates could be helpful for reducing the risk of bleeding and achieving favorable outcome.