Pipeline血流导向装置治疗颅内未破裂宽颈动脉瘤的短期随访

Short-term follow-up for unruptured wide-necked intracranial aneurysms treated with Pipeline embolization device

目的评价Pipeline血流导向装置(PED)治疗颅内未破裂宽颈动脉瘤的短期效果。方法回顾性连续纳入2015年10月至2016年9月在南昌大学第二附属医院神经外科应用PED治疗的颅内未破裂宽颈动脉瘤(颈体比≥0.5)患者15例,对其临床及影像资料进行分析,通过Kamran分级评价动脉瘤栓塞后闭塞率及载瘤动脉的改变,术后6~12个月行DSA复查。结果对15例未破裂宽颈动脉瘤共使用PED 15枚,其中13例眼动脉段动脉瘤,1例后交通动脉段动脉瘤,1例海绵窦段动脉瘤,技术成功率100%。PED置入即刻Kamran分级15例均为动脉瘤2级栓塞,载瘤动脉a级(2a级)。术后6~12个月DSA复查显示,14例动脉瘤4级栓塞,载瘤动脉a级(4a级),1例(眼动脉段动脉瘤)于术后6和12个月行2次复查,显示动脉瘤残留显影,动脉瘤3级栓塞,载瘤动脉a级(3a级)。未见分支动脉闭塞。无一例发生神经功能缺损。15例改良Rankin量表评分均为0。结论使用PED治疗颅内未破裂宽颈动脉瘤具有较高的闭塞率,其远期效果尚需要进一步随访。

Objective To evaluate the short-term effect of Pipeline embolization device（ PED） for the treatment of unruptured wide-necked intracranial aneurysms. Methods From October 2015 to September 2016,15 consecutive patients with unruptured wide-necked intracranial aneurysm（ aneurysm neck and aneurysm body ratio ≥0. 5） treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were enrolled retrospectively. Their clinical and imaging data were analyzed. Kamran scale was used to evaluate the embolization rate of aneurysms and the changes of the parent arteries. DSA examination was performed again at 6-12 months after operation. Results Fifteen PED were implanted in 15 patients with unruptured wide-necked intracranial aneurysms,including 13 ophthalmic artery aneurysms,1 posterior communicating artery aneurysm,and 1 cavernous sinus aneurysm. The technical success rate was 100%. Immediately after PED implantation,Karman rating of 15 cases were aneurysm grade 2 embolization,parent artery grade A（ grade 2 a）. DSA examination was performed again at 6-12 months after operation showed that 14 patients were aneurysm grade 4,parent artery was grade A（ grade4 a）. One patient（ ophthalmic artery aneurysm） underwent the second DSA examinations at 6 and 12 months after operation showed that the residual development of aneurysms. The aneurysm embolization was grade 3,and the parent artery was grade A（ grade 3 a）. No branch artery occlusion was observed. Non of them had neurological deficit. The modified Rankin scale score was 0 in all 15 patients. Conclusion The use of PED in the treatment of unruptured wide-necked intracranial aneurysms has a higher occlusion rate. Its long-term effect still needs further follow-up.