支架辅助弹簧圈栓塞与单纯弹簧圈栓塞治疗颅内破裂动脉瘤疗效的对比分析

Stent assisted coiling versus non-stent coiling for the management of ruptured intracranial aneurysms: A outcome comparison study

目的对比分析支架辅助弹簧圈栓塞(以下简称支架辅助栓塞)与单纯弹簧圈栓塞(以下简称单纯栓塞)治疗颅内破裂动脉瘤的安全性和有效性。方法纳入2011年1月至2018年1月郑州大学第一附属医院神经介入科采用血管内栓塞治疗的破裂动脉瘤患者1217例,其中支架辅助栓塞组631例,单纯栓塞组586例。回顾性分析两组患者术后即刻和随访期动脉瘤的栓塞程度(采用Raymond分级标准评估)及围手术期不良事件的发生率。以P<0.05为差异有统计学意义。结果栓塞即刻,631例支架辅助栓塞组中Raymond分级Ⅰ、Ⅱ、Ⅲ级者分别占65.0%(410例)、29.9%(189例)、5.1%(32例);586例单纯栓塞组中分别占51.4%(301例)、36.0%(211例)、12.6%(74例),两组比较P<0.01。支架辅助栓塞组术后出血事件的发生率为2.5%(16例),单纯栓塞组为5.1%(30例);两组缺血事件的发生率分别为6.3%(40例)、3.1%(18例),两组比较均P<0.05。两组患者的致残率均为1.0%(均为6例),致死率均为2.2%(分别为14例、13例),差异均无统计学意义(均P>0.05)。术后12个月,支架辅助栓塞组227例、单纯栓塞组102例行数字减影血管造影检查。其中支架辅助栓塞组Raymond分级Ⅰ、Ⅱ、Ⅲ级者分别占71.8%(163例)、22.9%(52例)、5.3%(12例),单纯栓塞组分别占53.9%(55例)、34.3%(35例)、11.8%(12例);复发率分别为11.9%(27例)、38.2%(39例),两组比较栓塞程度分级和复发率差异均有统计学意义,均P<0.01。结论与单纯弹簧圈栓塞比较,支架辅助弹簧圈栓塞治疗颅内破裂动脉瘤,栓塞效果好,复发率低;出血性并发症略低,缺血并发症略高,但不增加总体致残、致死的风险。

Objective To compare the safety and efficiency of stent assisted coiling(SAC)with non-SAC for the management of ruptured intracranial aneurysms.Methods A total of 1217 patients with ruptured intracranial aneurysms who underwent endovascular treatment at Neurointervention Department of the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2018 were retrospectively enrolled.Patients were categorized into SAC(n=631)and non-SAC(n=586)groups.We retrospectively analyzed the immediate postoperative occlusion degree and that at follow-up(based on Raymond scale)as well as perioperative complication rate in the two groups.The difference was considered as significant with P<0.05.Results In SAC group,the Raymond grades were gradeⅠin 65.0%(n=410),grade II in 29.9%(n=189)and gradeⅢin 5.0%(n=32),while those in non-SAC group were gradeⅠin 51.4%(n=301),gradeⅡin 36.0%(n=211)and gradeⅢin 12.6%(n=74),and the inter-group difference was significant(P<0.01).Postoperative rebleeding rate was 2.5%(n=16)in SAC group and 5.1%(n=30)in non-SAC group,and the rate of ischemic event was 6.3%(n=40)in SAC group and 3.1%(n=18)in non-SAC group,and those differences were significant(P<0.05).In both groups,the disability was 1.0%(n=6 in each group)and the mortality was 2.2%(n=14 in SAC and n=13 in non-SAC)without inter-group statistical difference(P>0.05).At 12 months post operation,DSA was performed in 227 cases of SAC group and 102 cases of non-SAC group.In SAC group,the Raymond grades were gradeⅠin 71.8%(n=163),gradeⅡin 22.9%(n=52)and gradeⅢin 5.3%(n=12),while those in non-SAC group were gradeⅠin 53.9%(n=55),gradeⅡin 34.3%(n=35)and gradeⅢin 11.8%(n=12).The recurrence rate was 11.9%(n=27)in SAC group and 38.2%(n=39)in non-SAC group.Those inter-group differences were significant(P<0.01).Conclusions Compared with non-SAC,SAC is associated with higher occlusion rate,lower recurrence rate,lower rebleeding rate and relatively higher rate of ischemic event.However,mortality and disability rate between two groups do not seem to differ.