血流导向装置桥接技术治疗颅颈部复杂动脉瘤的初步研究

Treatment of complex cervical and intracranial aneurysms using telescoping flow diverter devices:Premilitary experience

目的总结血流导向装置(FD)桥接技术治疗颅颈部复杂动脉瘤的初步经验,探讨该技术的适应证、技术要点及并发症防治策略方法回顾性纳入2010年8月至2019年4月海军军医大学长海医院神经外科采用FD桥接技术治疗的颅颈部复杂动脉瘤患者15例(15个动脉瘤)。其中5例采用PipeBne FDJ0例采用Tubridge FD;7例行计划性桥接,8例行补救性桥接;9例采用由远端向近端桥接,6例采用由近端向远端桥接;11例患者联合弹簧圈栓塞。术后随访采用改良Rankin量表评分(mRS)行预后评估,Ozkelly-Marotta(OKM)分级评估动脉瘤闭塞情况。结果15例患者技术成功率为100%。术后即刻14例患者动脉瘤内对比剂滞留,OKM分级A级者7例,B级者7例,C级者1例,无手术相关并发症。10例患者获得6~30(中位数:12个月)个月的数字减影血管造影(DSA)随访,其中7例动脉瘤完全闭塞,OKM分级D级;3例进一步血栓形成,OKM分级B级1例,C级2例。1例在术后9个月发生载瘤动脉闭塞,其余患者载瘤血管通畅。所有患者获得2-30(中位数:12个月)个月临床随访,1例术后9个月新发大面积脑梗死,对侧肢体偏瘫,末次随访mRS为3分,其余14例患者无新发神经功能缺损症状,mRS为0?2分.结论FD桥接技术治疗颅颈部复杂动脉瘤安全,短期疗效较好。瘤颈极宽的大型、巨大型或梭形动脉瘤可以首先考虑采用FD桥接技术治疗。

Objective To claiify the indications,technical essentials and complication preventing strategies concerning the telescoping flow diverter devices technique by sunmimizing our preniilitary experience in treatment of ceivical and intracranial aneuiysms using this technique.Methods Fifteen cases with 15 cervical and intracranial aneurysms treated with telescoping flow diverter devices at Depailment of Neurosurgery,Changhai Hospittd,Navy Military Medical University from August 2010 to April 2019 were retrospectively reviewed.Five aneurysms were treated with Pipeline embolization devices(PED)and 10 with Tiibridge flow diverters using telescoping technique.Among all aneuiysms,7 were treated in intended manner,while 8 aneurysms were treated in salvaging puipose.In 9 patients,the first flow diverter was deployed distally,followed by a second flow diverter deployed proximally in the parent artery(D-P manner),while in the remaining 6 patients,the first flow diverter was deployed proximally,followed by deployment of a second flow diverter(P-D manner).Coiling was also performed in 11 patients.Modified Rankin scale(niRS)was used to comprehensively evaluate the patients after surgery,and O,kelly-Marotta(OKM)grading scale was to evaluate aneurysm embolization.Results The techniques were succeeded perfonned in all patients.Contrast stasis was observed in 14 aneurysms immediately post procedure.According to OKM grading scale,7 were categorized as OKM giade A,7 as grade B and 1 as grade C.No procedure-related complications were encountered.In 10 patients who had DSA follow-up lasting for 6-30(median:12)months,7 aneurysms were totally occluded(OKM grade D),while further thrombosis was obseived in the other 3 aneurysms(OKM grade B in 1 and grade C in 2).The parent arteries were patent in all except for 1 patient who developed occlusion at 9 months postoperatively.All patients were clinically followed up for 2-30(median:12)months.During that period,no new neurological deficits were revealed(mRS:0-2),except for that 1 patient developing contralateral hemiplegia(mRS:3).Conclusion Telescoping flow diverter devices could be used to treat complicated cervical and intracranial aneurysms safely with good short-term effect.It should be considered with priority in treatment of large,giant or fusiform aneurysms with extremely wide neck.