颅内动脉瘤急性出血期支架辅助栓塞的治疗效果

CLINICAL EFFECT OF STENT-ASSISTED EMBOLIZATION IN TREATMENT OF INTRACRANIAL ANEURYSMS WITH ACUTE HEMORRHAGE

目的 了解颅内动脉瘤急性出血期支架辅助栓塞的治疗效果及其远期预后。方法 回顾性分析我院收治15例颅内动脉瘤破裂急性出血病人临床资料,病人术前全部行抗血小板治疗,采用颅内支架辅助栓塞动脉瘤治疗。观察病人即刻致密栓塞率及并发症发生情况。术后6个月和1年随访病人支架内再狭窄情况,采用格拉斯哥预后评分(GOS评分)、改良Rankin量表(mRS)及美国国立卫生研究院卒中量表(NHISS)评价神经功能恢复情况,Barthel评分评定生活质量改善情况。结果 15例病人均成功植入支架,其中1例病人出现动脉栓塞并发症,抢救无效死亡;其余病人均行弹簧圈栓塞治疗,术中未出现动脉瘤破裂、支架移位、支架膨胀不良及塌陷等并发症,3例病人出现脑血管痉挛,术中使用罂粟碱、术后用钙离子拮抗剂尼莫地平解痉后症状缓解。术后即刻影像学Cognard分级评估显示完全栓塞10例(71.43%),次全栓塞3例(21.43%),不完全栓塞1例(7.14%)。随访病人均未出现支架内再狭窄情况,6个月和1年后的GOS评分较术前均明显升高,NIHSS评分显著降低,Barthel评分也明显升高,差异均有统计学意义(F=19.32~43.44,P<0.05)。结论 支架辅助栓塞治疗颅内动脉瘤急性出血期的栓塞成功率较高,但仍存在一些急性并发症风险,手术成功的病人预后较好。

Objective To investigate the clinical effect of stent-assisted embolization in the treatment of intracranial aneurysms with acute hemorrhage and long-term prognosis of such patients. Methods A retrospective analysis was performed for the clinical data of 15 patients with ruptured intracranial aneurysms with acute hemorrhage who were admitted to our hospital. All patients received antiplatelet therapy before surgery, and stent-assisted embolization was used for the treatment of aneurysms. The immediate dense embolism rate and complications were observed for all patients. The patients were followed up for 6 months and 1 year to observe in-stent restenosis;Glasgow Prognostic Score (GOS), modified Rankin Scale (mRS), and National Institutes of Health Stroke Scale (NIHSS) were used to evaluate neurological function recovery, and modified Barthel Index (MBI) was used to evaluate the improvement in quality of life. Results All patients underwent successful stent implantation, among whom one patient experienced the complications of arterial embolization and then died after ineffective rescue, and all the other patients underwent coil embolization, with no complications such as rupture of aneurysm, stent migration, poor stent expansion, and stent collapse. Three patients experienced cerebral vasospasm, which was relieved by intraoperative application of papaverine and postoperative application of the calcium antagonist nimodipine. Imaging examination was performed immediately after surgery, and the Cognard classification showed complete embolization in 10 patients (71.43%), subtotal embolization in 3 patients (21.43%), and incomplete embolization in 1 patient (7.14%). No in-stent restenosis was observed during follow-up. At 6 months and 1 year after surgery, there were significant increases in GOS and MBI and a significant reduction in NIHSS score ( F =19.32-43.44, P <0.05). Conclusion Stent- assisted embolization has a high success rate in the treatment of intracranial aneurysms with acute hemorrhage, but there is still a risk of acute complications. Patients undergoing a successful surgery may have good prognosis.