Pipeline血流导向装置治疗颅内前循环复杂动脉瘤的中长期疗效

Mid-and long-term effects of flow diversion using PED in treatment of intracranial anterior circulation aneurysms

目的探讨Pipeline血流导向装置(PED)治疗颅内前循环复杂动脉瘤的中、长期疗效.方法回顾性分析新疆医科大学第一附属医院神经外科2015年5月至2018年9月应用PED治疗的58例颅内前循环动脉瘤患者的临床资料.其中动脉瘤未破裂者50例,破裂者8例.采用0'Kelly-Marotta(OKM)分级标准评估动脉瘤的闭塞程度,采用改良Rankin量表评分(mRS)评价患者的临床预后.结果58例患者均成功置入支架.术后即刻血管造影显示8例(13.8%)动脉瘤完全闭塞(OKM分级D级).术后分别于4~9(5.8±1.1)个月、10~18(12.8±2.1)个月及24~52(33.9±8.3)个月行短、中及长期随访.3个时期动脉瘤的完全闭塞率分别为87.7%(50/57)、98.2%(55/56)及100.0%(47/47),临床预后良好(mRS 0~2分)率分别为96.6%(56/58)、98.2%(55/56)及97.9%(46/47).58例患者中,术后13例(22.4%)发生并发症,2例(3.4%)死亡.其中出血性并发症2例(3.4%),脑积水1例(1.7%),无症状性分支血管闭塞4例(6.9%),视力下降2例(1例永久性失明),穿刺点血肿3例、上消化道出血1例.8例破裂动脉瘤患者,短、中及长期随访动脉瘤的完全闭塞比例分别为5/7、6/6及5/5;4例发生并发症,其中出血性并发症2例、梗阻性脑积水1例、视力下降1例,4例中死亡2例.结论PED治疗颅内前循环复杂动脉瘤严重并发症的发生率低;中、长期随访动脉瘤完全闭塞率高.破裂动脉瘤并发症发生比例较高,需慎重选择行PED治疗.

Objective To investigate the mid-and long-term outcomes of flow diversion using with Pipeline embolization device(PED)in treatment of intracranial complex anterior circulation aneurysms.Methods We retrospectively reviewed the clinical data of 58 intracranial complex anterior circulation aneurysms,including 8 ruptured and 50 unruptured aneurysms,which were treated with PED at Department of Neurosurgery,the First Affiliated Hospital of Xinjiang Medical University from May 2015 to September 2018.The occlusion extent and clinical outcomes were evaluated based on the O′Kelly-Marotta(OKM)grading scale and modified Rankin scale(mRS)respectively.Results All 58 patients were successfully implanted with PEDs and immediate post-operative angiography revealed complete occlusion(OKM grade D)in 8(13.8%)cases.Short-,mid-and long-term follow-ups were conducted at a mean period of 5.8±1.1 months(range:4-9 months),12.8±2.1 months(range:10-18 months)and 33.9±8.3 months(range:24-52 months)respectively.The results showed that the short-,mid-and long-term complete aneurysm occlusion(OKM grade D)rates were 87.7%(50/57),98.2%(55/56)and 100.0%(47/47)respectively.Correspondingly,the favorable outcome(mRS:0-2)rates were 96.6%(56/58),98.2%(55/56)and 97.9%(46/47)respectively.Of the 8 patients with ruptured aneurysm,there were 7,6 and 5 patients who underwent short-,mid-and long-term follow-up,and grade D occlusion was observed in 5,6 and 5 cases respectively.Complications occurred in 13(22.4%)of 58 patients and 2(3.4%)died.Among them,there were 2 cases(3.4%)of hemorrhage,1 case(1.7%)of hydrocephalus,4 cases(6.9%)of asymptomatic occlusion of branch vessel,2 cases of decreased vision(1 case with permanent blindness),3 cases of hematoma at puncture point and 1 case of upper gastrointestinal bleeding.Conclusions PED treatment of intracranial complex anterior circulation aneurysm is associated with low incidence of serious complications and high rate of complete occlusion at mid-and long-term follow-up.There seem to be a high rate of occlusion and favorable clinical outcomes for unruptured aneurysms.A relatively high incidence of complications is reported for ruptured aneurysm,and PED should be carefully selected.