血流导向装置Pipeline治疗颅内复杂动脉瘤的初步经验

Preliminary experiences of Pipeline embolization device for the treatment of complex intracranial aneurysms

目的初步探讨血流导向装置Pipeline(PED)在颅内复杂动脉瘤血管内介入治疗中的应用价值。方法回顾性连续纳入广东省人民医院神经外科2015年7月至2016年10月应用PED治疗的10例颅内不同类型复杂动脉瘤患者临床资料,对其手术方式、并发症和影像学结果进行分析。结果 10例患者中,男3例,女7例,年龄为32~68岁,平均(54±12)岁。颈内动脉瘤8例,大脑中动脉瘤1例,椎-基底动脉瘤1例;破裂动脉瘤2例,未破裂动脉瘤8例;囊状动脉瘤5例,(其中宽颈2例)梭形动脉瘤3例,夹层动脉瘤2例;中等大小动脉瘤(瘤径>5~15 mm)2例,大型动脉瘤2例(瘤径>15~25 mm),巨大型动脉瘤6例(瘤径>25 mm);复发性动脉瘤2例。10例均为单发性动脉瘤。使用PED联合弹簧圈栓塞3例,单纯PED置入7例;使用单枚PED 9例,使用3枚PED 1例。术后即刻造影均显示瘤腔内对比剂明显滞留;术后死亡1例,术后四肢瘫痪1例,其余8例患者无PED相关并发症。术后当日改良Rankin量表评分0分8例,5分1例,6分1例。术后随访14~28个月。结论 PED置入治疗不同类型颅内复杂动脉瘤相对安全有效,但也存在一定的致残、致死风险,需严格选择适应证并制定个体化治疗策略。

Objective To preliminarly investigate the application value of Pipeline embolization device（ PED） in the endovascular interventional treatment of complex intracranial aneurysms.Methods From July 2015 to October 2016,the clinical data of 10 consecutive patients with complex intracranial aneurysm treated with PED at the Department of Neurosurgery,Guangdong General Hospital were enrolled retrospectively. Their surgical modalities,complications,and imaging findings were analyzed.Results Of the 10 patients,7 were females and 3 were males,their age was 32-68 years（ mean age 54 ±1 2 years）. There were 8 patients with internal carotid artery aneurysm,1 with middle cerebral artery aneurysm,and 1 with vertebrobasilar artery aneurysm; there were 2 patients with ruptured aneurysm and 8 with unruptured aneurysm; there were 5 patients with saccular aneurysm（ 2 with wide-necked aneurysm）,3 with fusiform aneurysm,2 with dissecting aneurysm; there were 2 patients with medium aneurysm（ diameter 5-15 mm）,2 with large aneurysm（ diameter 15-25 mm）,6 with giant aneurysm（ diameter 25 mm）,and there were 2 patients with recurrent aneurysm. They were all single aneurysms. Three patients were treated with PED in combination with coil embolization,and 7 patients were treated with PED implantation alone. Nine patients were treated with one PED and 1 was treated with 3 PEDs. The immediate postoperative angiography revealed that the contrast agents in the aneurysm cavities were obviously stranded. One patient died after procedure and 1 had quadriplegia after procedure,and the remaining 8 patients had no PED-related complications. The modified Rankin scale score was 0 in 8 cases,5 in 1 case,and 6 in 1 case on the first postoperative day. They were followed up for 14 to 28 months. Conclusions The different types of intracranial aneurysms treated with PED implantation is relatively safe and effective,but there are also some risks of disability and death. Strictly selecting the indications and developing the individualized treatment strategies are needed.