小型未破裂颅内动脉瘤的血管内治疗

Endovascular therapy for small unruptured intracranial aneurysms

目的探讨血管内治疗小型未破裂颅内动脉瘤(small unruptured intracranial aneurysms, sUIAs)的有效性和安全性。方法回顾性纳入2008年1月至2018年1月期间在广州市第一人民医院脑系科接受血管内治疗的未破裂颅内动脉瘤患者。按照动脉瘤大小分为sUIAs组(直径<5 mm)和非sUIAs组(直径≥5 mm)。比较2组人口统计学、血管危险因素、动脉瘤特征、血管内治疗方式以及有效性、围手术期并发症和转归。结果共纳入未破裂颅内动脉瘤患者80例,其中sUIAs患者33例(41.25%),非sUIAs患者47例。sUIA组年龄[(51.1±9.7)岁对(61.2±8.1)岁;t=5.058,P<0.001]、动脉瘤最大直径[(3.6±1.1)mm对(8.2±3.2)mm;t=7.923,P<0.001]、颈宽[(3.1±0.5)mm对(4.5±2.5)mm;t=3.167,P=0.002]以及宽颈动脉瘤(3.0%对21.3%;χ2=7.213 ,P=0.007)和采用支架辅助栓塞(6.1%对23.4%;χ2=4.285,P=0.038)的患者构成比显著小于或低于非sUIAs组。两组间栓塞结果、围手术期并发症发生率和转归良好率相当,组间比较差异无统计学意义。结论对于sUIAs,血管内治疗是有效和安全的,与非sUIAs的血管内治疗相当。

Objective To investigate the efficacy and safety of endovascular therapy for small unruptured intracranial aneurysms (sUIAs). Methods Patients with unruptured intracranial aneurysms who underwent endovascular therapy in the Department of Neurology, Guangzhou First People's Hospital from January 2008 to January 2018 were retrospectively included. According to the size of the aneurysms, they were divided into the sUIAs group (diameter <5 mm) and the non-sUIAs group (diameter ≥5 mm). Demographics, vascular risk factors, aneurysm characteristics, and treatment method, effectiveness, perioperative complications, and outcomes of endovascular therapy were compared between the two groups. Results A total of 80 patients with unruptured intracranial aneurysms were enrolled, including 33 patients with sUIAs (41.25%) and 47 patients with non-sUIAs. The age of patients (51.1±9.7 years vs. 61.2±8.1 years;t=5.058, P<0.001), and the maximum diameter (3.6±1.1 mm vs. 8.2±3.2 mm;t=7.923, P<0.001) and neck width (3.1±0.5 mm vs. 4.5±2.5 mm;t=3.167, P=0.002) of aneurysms as well as the proportion of patients with wide-neck aneurysm (3.0% vs. 21.3%;χ2=7.213, P=0.007) and stent-assisted embolization (6.1% vs. 23.4%;χ2= 4.285, P= 0.038) in the sUIA group were significantly less than those of the non-sUIAs group. The embolization results, the perioperative complication rate and the good outcome rate were comparable between the two groups. Conclusion For sUIAs, endovascular therapy is effective and safe, comparable to endovascular therapy for non-sUIAs.