颅内动脉瘤栓塞术中“三圈模式”对瘤颈闭合的应用研究

The application of “three coils model” closure the aneurysms neck in the embolization treatment

目的探讨颅内动脉瘤栓塞术中应用"三圈模式"技术对动脉瘤颈闭合的价值。方法 2015年10月至2016年3月期间在河北医科大学第二医院神经外科经介入栓塞治疗的116例患者共计135个囊性动脉瘤,将入组动脉瘤按收治顺序随机分为"三圈模式"组(66个动脉瘤)和传统栓塞组(69个动脉瘤),动脉瘤大小平均为4.67+1.85mm;其中包括单纯栓塞46个动脉瘤,支架辅助栓塞89个;应用VFC圈91枚,纤毛圈93枚,水凝胶涂层圈73枚,填塞圈324枚;选用支架均为Microvention公司生产的LVIS支架。依据Raymond分级评价即刻栓塞效果,比较两组病例6个月随访时瘤颈闭合率。结果 135例动脉瘤均实现成功栓塞,其中66例动脉瘤采用三圈模式治疗,即刻栓塞效果:Raymond分级Ⅰ级47个,Ⅱ级7个,Ⅲ级12个,其中45例动脉瘤采用支架辅助,经6个月共随访55例患者,没有瘤颈、瘤体残留及复发病例,瘤颈闭合率100%;传统栓塞治疗组的69例动脉瘤应用支架辅助栓塞44例,栓塞后即可造影均获得Raymond分级Ⅰ级疗效,经随访6个月共56例患者,6例动脉瘤颈残留并给予再次栓塞治疗,瘤颈闭合率89.3%。两组病例瘤颈闭合率具有统计学差异(P<0.05)。两组病例在使用支架类型、数量比较差异无统计学意义(P>0.05)。结论瘤颈闭合是动脉瘤栓塞的核心理念,三圈模式对于颅内动脉瘤栓塞术后瘤颈闭合较传统栓塞模式具有更高瘤颈闭合率。

Objective To explore the value of three coils model for intracranial aneurysms neck closure in the aneurysms embolization. Method One hundred and sixteen patients with 135 intracranial aneurysms were embolizated by means of three coils model and traditional method in the department of neurosurgery, the Second Hospital of Hebei Medical University from January 2016 to June 2016. The aneurysms embolization methods were divided into randomly three coils model and traditional modes according the patients admitted timely. The former was 66 and the latter was 69 cases. Average size of the aneurysm was 4.67+1.85 millimetre. Simple-embolism were 46 cases and stent-assisted were 89. The coils type including VFC were 91, Axium PGLA were 93, Hydrogel coils were 73 and common packed coils were 324. The stent type were LVIS producted by Microvention corporation( USA). The embolization results were evaluated according to Raymond grade by immediate angiography post-embolization. The rate of aneurysm neck closure were counted in the 6 months following-up. Results The aneurysms were treated by embolization ways successfully. Sixty-six aneurysms were treated under the three coils model and 69 cases were treated by the traditional method retrospectively. Forty-five aneurysms were embolizated by stent-assisted in the former group.Raymond grade I were 47,grade II were 7 and grade III were 12 cases by immediate angiography post-embolization in the former group and 55 cases no reccurence in the 6 months following-up. Forty-four aneurysms were embolizated by stent-assisted in the latter group. Sixty-nine aneurysms receieved Raymond grade I by immediate angiography post embolization. Six of 56 cases get the second embolization due to aneurysms neck residual in the 6 months following up.The rate of closure of aneurysm neck was one hundred percent and 89.3 percent in three coils model techniquegroup and traditional one respectively. The cure rate in the former group was higher than the latter one( P<0.05).Conclusion The closure of aneurysm neck is the core idea for the aneurysm embolization. Three coils model could get more uniform and compact embolization than the traditional method for the intracranial saccular aneurysms.