血流导向装置联合弹簧圈栓塞治疗颅内动脉瘤的效果分析

Flow diversion combined with coil embolization in treatment of intracranial aneurysms:an efficacy analysis

目的探讨血流导向装置联合弹簧圈栓塞治疗颅内动脉瘤的疗效。方法郑州大学第一附属医院神经介人科自2015年4月至2019年9月采用血流导向装置治疗颅内动脉瘤患者110例,其中采用单纯血流导向装置治疗62例,采用血流导向装置联合弹簧圈栓塞治疗48例。回顾性分析患者的临床和影像学资料,比较单纯血流导向装置治疗组与血流导向装置联合弹簧圈栓塞治疗组患者的疗效和安全性的差异。结果110例患者均成功植入血流导向装置,技术成功率100%。血流导向装置联合弹簧圈栓塞治疗组术后即刻动脉瘤完全愈合率(16.7%)高于单纯血流导向装置治疗组(1.6%),差异有统计学意义(P<0.05)。单纯血流导向装置治疗组、血流导向装置联合弹簧圈栓塞治疗组患者的并发症发生率(4.84%vs.4.17%)差异无统计学意义(P>0.05)。110例患者随访时间(6.72+3.80)个月,随访时血流导向装置联合弹簧圈栓塞治疗组患者改良Rankin量表(mRS)评分均为0分;单纯血流导向装置治疗组患者mRS评分I分.2分各一例。mRS评分0分60例;2组患者mRS评分的分布差异无统计学意义(P>0.05)。血流导向装置联合弹簧圈栓塞组动脉瘤最终完全愈合率(83.3%)高于单纯血流导向装置治疗组(66.1%).差异有统计学意义(P<0.05)。结论血流导向装置治疗颅内动脉瘤具有较高的愈合率和安全性。选择性采用血流导向装置辅助弹簧圈栓塞能够更有效促进动脉瘤的早期愈合。

Objective To explore the efficacy of flow diversion combined with coil embolization in treatment of intracranial aneurysms.Methods The clinical data of 110 patients with intracranial aneurysms treated by flow diversion in our hospital from April 2015 to September 2019 were retrospectively analyzed.In these patients,48 were treated by flow diversion combined with coil embolization and 62 were treated by flow diversion alone;the efficacy and safety of patients from the two groups were compared.Results Blood flow diversion was successfully implanted into all 110 patients,with technical sucess rate of 100%.Immediate complete occlusion rate in the flow diversion combined with coil embolization group(16.7%)was significantly higher than that in the flow diversion group(1.6%,P<0.05).There was no significant difference in the incidence of perioperative complications between flow diversion combined with coil embolization group and flow diversion group(4.17%vs.4.84%,P>0.05).During the mean follow-up of 6.72+3.80 months,modified Rankin scale(mRS)scores of patients in the flow diversion combined with coil embolization group were all 0;one patient had mRS score of 1,one patients had mRS scores of 2,and 60 patients had mRS score of 0 in patients from the flow diversion group;no significant difference was noted between the two groups(P>0.05).Patients in the flow diversion combined with coil embolization group had significantly higher rate of complete ancurysm occlusion than those in the flow diversion group(88.3%vs.66.1%,P<0.05).Conclusions Flow diversion is an effective and safe strategy in treatment of intracranial aneurysms.Flow diversion combined with coil embolization can effectively promote early healing of aneurysms in selective patients.