Pipeline栓塞装置治疗颅内复杂动脉瘤临床观察

The treatment of complex intracranial aneurysms with Pipeline embolization device:clinical observation

目的探讨Pipeline栓塞装置(PED)辅助加圈与不加圈治疗颅内复杂动脉瘤的安全性和有效性。方法回顾性总结2015年4月至2018年3月郑州大学第一附属医院采用PED治疗的35例(36枚)颅内复杂动脉瘤患者临床资料。其中男11例,女24例;年龄22~73岁,平均(53.6±12.6)岁。动脉瘤位于颈内动脉33枚,大脑中动脉1枚,椎动脉2枚;破裂动脉瘤1枚,未破裂35枚;动脉瘤呈囊性30枚,梭形4枚,夹层2枚;动脉瘤为小型4枚,中型21枚,大型8枚,巨大型3枚。对手术方式、并发症和影像学结果进行分析。结果PED加圈组15枚,单纯PED组21枚。两组患者手术成功率为100%。共植入PED 40枚,支架开放不良5枚(PED加圈组4枚,PED组1枚)。发生围手术期轻微缺血事件4例(PED加圈组1例,PED组3例),均为轻微脑梗死,未遗留神经功能缺失;PED加圈组1例术中发生导丝操作相关出血性并发症,遗留轻度神经功能障碍;两组均无致死性并发症。出院时改良Rankin量表(mRS)评分0分33例,1分1例,3分1例。23例(65.7%)获影像学随访,中位随访6个月(3~24个月),PED加圈组、PED组动脉瘤完全闭塞分别为9例(90%,9/10)、9例(69.2%,9/13),瘤颈残留分别为1例(10%,1/10)、3例(23.1%,3/13);PED组1例与术后即刻造影无明显变化(7.7%,1/13)。结论PED加圈治疗颅内复杂动脉瘤安全有效,可促进瘤囊内血栓形成,可能减少延迟性术后动脉瘤破裂风险,在提高复杂动脉瘤完全闭塞率的同时,并不增加手术操作复杂程度和风险。

Objective To evaluate the safety and effectiveness of Pipeline embolization device(PED),with or without additional use of coils,in the treatment of complex intracranial aneurysms.Methods The clinical data of 35 consecutive patients with complex intracranial aneurysm(36 aneurysms in total),who were treated with PED at the First Affiliated Hospital of Zhengzhou University of China during the period from April 2015 to March 2018,were retrospectively summarized.The patients included 11 males and 24 females,aged 22-73 years,with an average age of(53.6±12.6)years.The aneurysms were located at the internal carotid(n=33),middle cerebral artery(n=1)and vertebral artery(n=2).One aneurysm was ruptured and 35 aneurysms were unruptured.Thirty aneurysms were saccular in shape,4 aneurysms were fusiform in shape,and 2 aneurysms took the form of dissection.In aspect of size,the aneurysms were small(n=4),medium(n=21),large(n=8)or giant(n=3).The operative methods,complications and imaging findings were analyzed.Results PED plus coils was used for 15 aneurysms(PED+coil group),and simple PED was employed for 21 aneurysms(simple PED group).The success rate of operation was 100%in both groups.A total of 40 PEDs were implanted,and poorly opening of 5 PEDs was observed,including 4 PEDs in PED+coil group and one PED in simple PED group.Perioperative mild ischemic events occurred in 4 patients,including one patient in PED+coil group and 3 patients in simple PED group,all of them were mild cerebral infarction,and there was no residual neurological deficit.During the operation,one patient of PED+coil group developed guide-wire manipulation-related hemorrhagic complication,resulting in permanent mild neurological dysfunction.No fatal complications occurred in both groups.At the time of discharge,the modified Rankin scale(mRS)score of 0 point was obtained in 33 patients,one point in one patient,and 3 points in one patient.Postoperative imaging follow-up for a median of 6 months(3-24 months)was conducted in 23 patients(65.7%).In PED+coil group and simple PED group the complete occlusion of aneurysm was obtained in 9 patients(90%,9/10)and 9 patients(69.2%,9/13)respectively,and the residual aneurysm neck was detected in one patient(10%,1/10)and 3 patients(23.1%,3/13)respectively.In one patient(7.7%,1/13)of simple PED group,immediate postoperative angiography found that the aneurysm showed no obvious change.Conclusion For the treatment of complex intracranial aneurysms,PED plus coils therapy is safe and effective,it can promote intracapsular thrombosis of aneurysms and may reduce the risk of postoperative delayed aneurysm rupture.While increasing the complete occlusion rate of complex aneurysms,PED plus coils therapy does not increase the complexity and risk of operation.