Pipeline血流导向装置治疗复杂颅内动脉瘤的安全性及中期疗效

Safety and mid-term outcome of Pipeline embolization device in the treatment of complex intracranial aneurysms

目的评价Pipeline血流导向装置（PED）治疗复杂颅内动脉瘤的安全性和中期疗效。 方法回顾性纳入郑州大学人民医院介入科2015年1月至2016年10月行血管内治疗的53例复杂颅内动脉瘤患者，所有患者均经股动脉入路于载瘤动脉置入PED，操作结束即刻行数字减影血管造影（DSA）检查PED位置及贴壁情况，并行头颅CT扫描评估有无颅内出血。术后5～7 d根据病情需要对患者行头颅CT或MRI检查，并采用改良Rankin量表评分（mRS）评估患者预后。术后3、6、12、24个月对所有患者进行临床随访，采用mRS评分评估患者预后；术后6、12个月行影像学随访，对动脉瘤栓塞程度进行O＇ kelly-Marotta（OKM）分级评估。 结果53例患者的70个动脉瘤共置入58枚PED，手术成功率为100.0%。操作结束即刻行DSA检查显示，PED均准确覆盖瘤颈，且贴壁良好。头颅CT检查未发现颅内出血。9.4%（5/53）的患者发生围手术期并发症。术后5～7 d行CT或MRI检查，发现蛛网膜下腔出血、PED置入侧大脑半球肿胀，急性脑梗死各1例；行mRS评分，其中0分25例，1分23例，2分1例，4分3例，6分1例。47例患者获得临床随访，随访时间为10～30个月，中位时间为16（14，20）个月。mRS评分为0分38例，1分6例，2分、3分、4分各1例。43例获得影像学随访，随访时间为3～19个月，中位时间为6（4.5，10.0）个月。43例患者58个动脉瘤的OKM分级为，D级为34个，C级为9个，B级为15个；74.1%（43/58）的动脉瘤为次全以上闭塞（OKM分级为D，C级）。无动脉瘤复发。 结论PED治疗复杂颅内动脉瘤安全性较好，中期随访疗效良好，且无动脉瘤复发，但仍需警惕严重并发症发生。

ObjectiveTo evaluate the mid-term safety and efficacy of Pipeline embolization device （PED） in the treatment of complex intracranial aneurysms. MethodsA retrospective analysis was conducted on the clinical data of 53 patients with 70 complex intracranial aneurysms who underwent endovascular interventional treatment at the Cerebrovascular Division of Interventional Department, People＇s Hospital of Zhengzhou University from January 2015 to October 2016. All patients were implanted with PED through the femoral artery under general anesthesia. Digital subtraction angiography （DSA） was performed at the end of the operation to examine the position and possible malposition of PED, and the CT scans were performed to assess intracranial hemorrhage. The CT or MRI scans were performed on day 5-7 post operation if necessary, and the modified Rankin Scores （mRS） were used to evaluate the prognosis of the patients. Clinical follow-up was performed at 3, 6, 12 and 24 months post operation and the prognosis was evaluated based on the mRS scores. The imaging follow-up was performed at 6, 12 months post operation, and the degree of aneurysm occlusion was graded by OKM （O＇ Kelly-Marotta） grading scale. ResultsAll 53 patients with 70 aneurysms were successfully implanted with 58 PEDs. Among them, 45 aneurysms were treated with PED alone and 25 aneurysms were treated with PED-assisted coil embolization. At the end of the operation, the DSA examination showed that PEDs were all accurately covered with the aneurysm necks and complete stent apposition was observed. No intracranial hemorrhage was revealed by CT scan. Perioperative complications occurred in 5 patients （9.4%, 5/53）. At 5-7 days post operation, the CT or MRI scan showed subarachnoid hemorrhage in 1 patient, cerebral hemispherical swelling at PED-implanted side in 1 and acute cerebral infarction in 1. The mRS scores were assessed and they were 0 in 25 patients, 1 in 23, 2 in 1, 4 in 3 and 6 in 1. A total of 47 patients obtained clinical follow-up 10-30 months post operation with a median of 16 （14, 20） months. The mRS scores were 0 in 38 patients, 1 in 6, 2 in 1, 3 in 1 and 4 in 1. There were 43 patients （58 aneurysms） who obtained imaging follow-up 3-19 months post operation with a median of 6 （4.5, 10.0） months. The OKM scale of 58 aneurysms in 43 patients were assessed which indicated grade D in 34 patients, C in 9 and B in 15. Complete and subtotal occlusion was conducted for 43 out of 58 aneurysms （74.1%, 43/58） with no recurrence. ConclusionsThe treatment of complex intracranial aneurysms with PED seems safe and effective in mid-term follow-up and serious complications remain to be noted. Long-term safety and efficacy needs to be further studied.