支架辅助弹簧圈栓塞颅内宽颈破裂动脉瘤的疗效分析

Stent-assisted embolization of acutely rupture wide-necked intracranial aneurysms: complication and efficacy

目的评估单中心支架辅助弹簧圈栓塞颅内宽颈破裂动脉瘤的安全有效性和长期随访的疗效。方法回顾性分析普宁市人民医院神经外科自2011年1月至2015年12月行支架辅助栓塞颅内宽颈破裂动脉瘤的52例患者的临床及影像学资料。主要搜集的资料包括:患者年龄、性别、高血压、Hunt-Hess分级、m Fisher分级、支架类型、支架置入时机、影像学结果、并发症情况和长期随访结果;利用单因素分析和多因素分析的方法探讨影响围手术期并发症的因素。结果在52例患者中,围手术期相关并发症发生率9.615%(5例),包括:术中出血1例、术后出血1例,术后脑梗3例。Logistic回归分析高级别Hunt-Hess分级[比值比(OR)=18.09,95%可信区间(95%CI):1.03~316.61,P=0.047]、高级别m Fisher分级(OR=10.25,95%CI:1.41~75.52,P=0.021)是预测手术相关并发症的独立因素。在得到了临床随访结果的40例患者中[随访率76.9%,(22.1±4.5)个月],37例患者有较好的临床疗效(m RS 0分)。影像学随访的患者39例,其中4例出现动脉瘤复发。结论支架辅助栓塞破裂宽颈动脉瘤是可行的治疗方案之一,其并发症率在可接受范围内。Hunt-Hess分级和m Fisher分级是预测手术相关并发症的独立因素。

Objective To evaluate the safety and angiographic and clinical outcome of stent-assisted coil placement for acutely ruptured wide-necked intracranial aneurysms treated in a single center.Methods A total of52rupture wide-necked aneurysms that were treated with stent-assisted coiling from January2011to December2015were reviewed retrospectively at our institution.Data collected and analyzed included:patient demographics;morphologic features of the aneurysm;treatment results and follow-up results.Results There were5(9.6%)overall procedure-related complications in52patients,including:1intraprocedural aneurysm ruptures,1postoperative hemorrhage,2thromboembolic complications.In a logistic regression analysis,the complications differed significantly in the patients with high Hunt-Hess grade(OR=18.09,95%CI:1.03-316.61,P=0.047),high mFisher grade(OR=10.25,95%CI:1.41-75.51,P=0.021).Favorable outcomes were seen in37of those patients in along-term follow-up.Conclusion Stent-assisted coiling of ruptured wide-necked intracranial aneurysms is effective,and provides durable aneurysm closure.High Hunt-Hess grade and mFisher grade is association with significantly higher complication rates.