血流导向装置治疗颅内大型未破裂动脉瘤的临床疗效分析

Clinical efficacy analysis of flow diverter in the treatment of large unruptured intracranial aneurysms

目的探讨血流导向装置(FD)治疗颅内大型未破裂动脉瘤的安全性及疗效。方法回顾性分析郑州大学人民医院(河南省人民医院)脑血管介入科2015年2月至2019年7月应用FD(Pipeline+Tubridge)治疗的颅内大型(最大径≥10 mm)未破裂动脉瘤患者的临床资料,共92例(95个动脉瘤)。采用改良Rankin量表评分(mRS)标准评价临床预后,采用O′Kelly-Marotta(OKM)分级标准评估动脉瘤闭塞情况;采用多因素logistic回归分析方法分析影响术后6个月动脉瘤完全闭塞的相关因素。结果92例患者95个动脉瘤共置入101枚FD,手术成功率为100%。术后神经系统并发症发生率为4.3%(4/92),其中缺血性1例,出血性2例(死亡1例),术后出现烦躁等症状1例。77例患者获临床随访,中位随访时间为12(1~51)个月。至末次随访,mRS 0分70例,1分5例,2分、3分各1例。55例患者(56个动脉瘤)行影像学随访,末次中位随访时间为6(3~29)个月,动脉瘤完全闭塞(OKM分级D级)40个(71.4%,40/56),支架内狭窄的发生率为7.1%(4/56)。52例患者(53个动脉瘤)6个月随访时动脉瘤完全闭塞34个(64.2%,34/53),支架内狭窄的发生率为7.5%(4/53)。多因素logistic回归分析显示,联合弹簧圈填塞是术后6个月时动脉瘤完全闭塞的独立影响因素(OR=8.98,95%CI:1.87~43.22,P=0.006)。结论FD治疗颅内大型未破裂动脉瘤的手术成功率高,安全性好,但应警惕严重并发症的发生;联合弹簧圈填塞可促进动脉瘤完全闭塞。

Objective To evaluate the safety and efficacy of flow diverter(FD)in the treatment of large(maximum diameter≥10 mm)unruptured intracranial aneurysms.Methods A total of 92 patients harboring 95 large unruptured intracranial aneurysms who underwent treatment with FD(Pipeline+Tubridge)at Department of Cerebrovascular Intervention,Zhengzhou University People's Hospital,Henan Provincial People's Hospital from February 2015 to July 2019 were enrolled into this retrospective study.The modified Rankin scale(mRS)was used to evaluate the clinical outcomes at follow-up,and O′Kelly-Marotta(OKM)grading scale was used to evaluate the occlusion of aneurysm.Multivariate logistic regression analysis was used to explore the influencing factors which could affect the aneurysm occlusion rate at 6-month follow-up.Results A total of 101 devices of FD were employed in 92 patients with 95 aneurysms,all of whom underwent successful operation.The incidence of neurological complications was 4.3%(4/92),which included 1 case of thromboembolic complication,2 hemorrhagic events(1 death)and 1 case of postoperative irritability.Seventy-seven patients obtained clinical follow-up with a median of 12(1-51)months.The mRS was 0 in 70 patients,1 in 5,2 in 1 and 3 in 1.There were 55 patients with 56 aneurysms who underwent the latest follow-up at a median of 6(3-29)months post operation,and the complete occlusion(Grade D of OKM grading scale)rate was 71.4%(40/56),the in-stent stenosis rat was 7.1%(4/56).There were 52 patients with 53 aneurysms who obtained the 6-month imaging follow-up and the complete occlusion rate was 64.2%(34/53),the in-stent stenosis rat was 7.5%(4/53).Multivariate logistic regression showed that adjunctive coiling was the independent factor which affected the aneurysm occlusion rate at 6-month follow-up significantly(OR=8.98,95%CI:1.87-43.22,P=0.006).Conclusions The use of FD seems safe in the treatment of large unruptured intracranial aneurysms with a high procedure success rate.However,serious complications remain to be noted.Meanwhile,adjunctive coiling could promote the complete occlusion of intracranial aneurysms.