辅助技术及支架植入弹簧圈栓塞治疗颅内动脉瘤的疗效比较

The efficacy comparison of spring coil embolization under auxiliary technology and stent implantation spring coil embolization in the treatment of intracranial aneurysms

目的比较辅助技术下弹簧圈栓塞及支架植入弹簧圈栓塞治疗颅内动脉瘤的临床效果。方法回顾性分析行血管内栓塞治疗的102例颅内动脉瘤患者病历资料,根据治疗方式不同分为支架植入弹簧圈栓塞组(n=58例)和辅助弹簧圈栓塞组(n=44例)。评估两组术后动脉瘤栓塞治疗效果,比较两组术后住院时间、治疗6个月后美国国立卫生院神经功能缺损(NIHSS)评分、生活活动能力(ADL)评分变化及预后情况,同时比较两组并发症发生情况。结果两组在动脉瘤术后完全栓塞率、次全栓塞率、部分栓塞率等方面比较差异无统计学意义(72.73%,20.45%,6.82%vs68.97%,25.86%,5.17%)(P>0.05);辅助弹簧圈栓塞组患者术后住院时间(10.45±2.32)d明显少于支架植入弹簧圈栓塞组(12.97±2.56)d(P<0.05),但两组术后NIHSS评分、ADL评分比较差异无统计学意义(6.63±3.81,60.12±9.80vs8.35±4.03,59.63±9.47)(P>0.05);辅助弹簧圈栓塞组患者恢复良好率(68.18%)明显高于支架植入弹簧圈栓塞组(55.17%)(P<0.05),而死亡率(0%)明显低于支架植入弹簧圈栓塞组(6.90%)(P<0.05);辅助弹簧圈栓塞组患者术中脑血管痉挛、术后消化道出血、术后脑梗塞等并发症发生率(9.09%,6.82%,4.55%)明显低于支架植入弹簧圈栓塞组(25.86%,20.69%,17.24%)(P<0.05),而两组动脉瘤复发率比较差异无统计学意义(13.64%vs10.34%)(P>0.05)。结论辅助技术下弹簧圈栓塞较支架植入弹簧圈栓塞可明显缩短颅内动脉瘤患者术后住院时间,显著改善患者预后和降低术后并发症发生率。

Objective To compare the clinical effect of spring coil embolization under auxiliary technology and stent implantation spring coil embolization in treatment of intracranial aneurysms. Methods The medical records of 102 patients with intracranial aneurysms who were treated by endovascular embolization were retrospectively analyzed. These patients were divided into stent implantation spring coil embolization (n=58) and aux iliary spring coil embolization group(n=44) according to different treatment methods. The therapeutic effect of postoperative aneurysm embolization for patients of the two groups was evaluated. The postoperative hospitalization time, NIHSS score, ADL score and prognosis of patients in the two groups 6 months after treatment were compared. The incidence of complications of patients in the two groups was compared. Results There was no significant difference between the two groups about complete embolization rate, sub-total embolization cate and partial embolization rate after aneurysm surgery(72.73%, 20.45%, 6.82% vs 68.97%, 25.86%, 5.17%)(P>0.05). The postoperative hospitalization time of patients in the assistive coil embolization group (10.45±2.32) d was significantly less than that in the stent-assisted coil embolization (12.97±2.56) d (P<0.05), but there was no significant difference in postoperative NIHSS score and ADL score between the two groups [(6.63±3.81),(60.12±9.80) vs (8.35 ±4.03),(59.63 ±9.47)(P>0.05)]. The recovery rate of patients in the assistive coil embolization group (68.18%) was significantly higher than that in the stent-assisted coil embolization group (55.17%)(P<0.05),while the mortality rate (0%) was significantly lower than that in the stent -assisted coil embolization group (6.90%)(P<0.05). The incidence of complications such as intraoperative cerebral vasospasm, postoperative gastrointestinal bleeding and postoperative cerebral infarction (9.09%, 6.82%, 4.55%) was significantly lower in the assistive coil embolization group than that in the stent -assisted coil embolization group (25.86%, 20.69%, 17.24%)(P<0.05), while there was no significant difference in aneurysm recurrence rate between the two groups (13.64% vs 10.34%)(P>0.05). Conclusion Compared with stent implantation spring coil embolization, the spring coil embolization under auxiliary technology can significantly shorten the postoperative hospitalization time, improve the prognosis and reduce the incidence of postoperative complications.