Pipeline血流导向装置治疗大脑中动脉复杂动脉瘤的初步经验

Preliminary experience of treating complex middle cerebral artery aneurysms with Pipeline embolization device

目的探讨Pipeline血流导向装置(PED)治疗大脑中动脉复杂动脉瘤的安全性和效果。方法回顾性连续纳入2015年12月至2018年6月南昌大学第二附属医院神经外科使用PED治疗大脑中动脉复杂动脉瘤住院患者7例,均为未破裂动脉瘤,并分析其临床及随访资料。使用Kamran分级评价动脉瘤栓塞即刻效果及载瘤动脉的改变。术后6个月,采用Raymond栓塞分级评价栓塞效果;采用改良Rankin量表(mRS)评分评价预后,0~2分为预后良好,3~6分为预后不良,6分为死亡。结果7例大脑中动脉复杂动脉瘤患者均成功置入单枚PED,其中单纯使用PED栓塞2例,PED联合弹簧圈栓塞5例。栓塞后即刻造影,Kamran分级2a级7例,术后mRS评分0分6例,1分1例;1例M1段动脉瘤术中支架内局部急性血栓形成;1例M1段动脉瘤术后同侧枕叶小灶梗死。术后6~12个月随访,7例均为Raymond栓塞分级Ⅰ级,其中6例患者动脉瘤未显影,载瘤动脉通畅;1例大脑中动脉分叉处动脉瘤术后6个月复查动脉瘤少许显影,术后12个月时复查动脉瘤未显影,载瘤动脉通畅。术中及术后随访期间(6~18个月),7例均无动脉瘤破裂出血或脑实质出血,无神经功能缺损。结论PED治疗大脑中动脉复杂动脉瘤安全、有效,远期效果尚需进一步随访及大样本研究证实。

Objective To investigate the safety and efficacy of Pipeline embolization device(PED)for the treatment of complex middle cerebral artery aneurysms.Methods From December 2015 to June 2018,7 patients with complex middle cerebral artery unruptured aneurysms and treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were recruited.The clinical and follow-up data were analyzed.The Kamran classification was used to evaluate the immediate effect of aneurysm embolization and the changes of parent artery.At 6 months after operation,the effect of embolization was evaluated by Raymond grading;the modified Rankin scale(mRS)was used to evaluate prognosis:0-2 for good prognosis,3-6 for poor prognosis,and 6 for death.Results The 7 patients with complex middle cerebral artery aneurysms were successfully treated with one PED,including 2 patients with single PED and 5 combined with coiling.Digital subtraction angiography(DSA)were performed immediately after PED implantation.All had Kamran classification 2a at immediate angiography after embolization.The postoperative mRS score was 0 in 6 patients and 1 in 1 patient.One patient with M1 aneurysm had acute in-stent thrombosis and another one with M1 aneurysm had mini-focal occipital lobe cerebral infarction.All 7 patients were Raymond classificationⅠduring postoperative follow-up from 6 to 12 months.Among them,6 patients had aneurysms total occlusion with patent parent artery.For the remaining one patient,the aneurysm was found slightly residual at the middle cerebral artery bifurcation but was totally occluded with parental artery patent at 12 months.There were no aneurysmal rupture,cerebral parenchymal hemorrhage,and neurological defects in the 7 patients during intraoperative and postoperative follow-up periods(6 to 18 months).Conclusions Embolization of complex cerebral artery aneurysms with PED is effective and safe,but its long-term effect still needs to be validated by longer follow-up results and large sample-sized trials.