球囊辅助技术在颅内动脉瘤弹簧圈栓塞术中破裂中的应用

Application of balloon-assisted technique for intraoperative rupture during intracranial aneurysm coil embolization

目的:探讨球囊辅助技术用于处理颅内动脉瘤弹簧圈栓塞术中破裂(intraprocedural aneurysmal rupture, IAR)的有效性及其对患者临床转归的影响。方法:回顾性纳入2013年1月至2019年1月在空军军医大学西京医院接受弹簧圈栓塞且并发IAR的颅内动脉瘤患者。按术中止血方式分为球囊辅助止血组和快速填塞止血组。在术后3个月随访时采用改良Rankin量表进行临床转归评价,0~2分定义为转归良好。采用多变量 logistic回归分析确定临床转归的独立影响因素。 结果:共纳入77例IAR患者,其中46例(59.74%)采用球囊辅助止血,31例(40.26%)采用快速填塞止血。在51例(66.23%)具有3个月随访资料的患者中,转归良好32例(62.75%),转归不良19例(37.25%)。单变量分析显示,球囊辅助止血组与快速填塞止血组之间IAR至处理时间、IAR至确认止血时间、术后Fisher分级改变以及转归良好率差异有统计学意义( P均<0.05)。转归良好组与转归不良组之间IAR处理方式、IAR至处理时间、IAR至确认止血时间、术后Fisher分级改变差异有统计学意义( P均<0.05)。多变量 logistic回归分析显示,球囊辅助止血(优势比0.234,95%可信区间0.056~0.990;P=0.048)以及IAR至确认止血时间≤10 min(优势比0.097,95%可信区间0.024~0.397;P=0.001)是IAR患者转归良好的独立保护因素。 结论:使用球囊辅助技术处理颅内动脉瘤弹簧圈栓塞IAR能达到满意的止血效果,并能改善患者临床转归。

Objective To investigate the effectiveness of balloon-assisted technique for the treatment of intraprocedural aneurysmal rupture(IAR)during intracranial aneurysm coil embolization and its impact on the clinical outcomes of patients.Methods Patients with intracranial aneurysm received coil embolization and complicated with IAR in Xijing Hospital of Air Force Medical University from January 2013 to January 2019 were enrolled retrospectively.They were divided into balloon-assisted hemostasis group and rapid packing hemostasis group according to the methods of intraoperative hemostasis.The modified Rankin Scale was used to evaluate the clinical outcomes at 3-month postoperative follow-up.A score of 0-2 was defined as a good outcome.Multivariate logistic regression analysis was used to identify the independent influencing factors of clinical outcome.Results A total of 77 patients with IAR were enrolled,of which 46(59.74%)used balloon-assisted hemostasis,and 31(40.26%)used rapid packing hemostasis.In 51 patients(66.23%)with 3-month follow-up data,32(62.75%)had good outcomes,and 19(37.25%)had poor outcomes.Univariate analysis showed that there were significant differences in time from IAR to treatment,time from IAR to confirmed hemostasis,postoperative Fisher grade changes,and good outcomes between the balloon-assisted hemostasis group and the rapid packing hemostasis group(all P<0.05).There were significant differences in IAR treatment methods,time from IAR to treatment,time from IAR to confirmed hemostasis,and postoperative Fisher grade changes between the good outcome group and the poor outcome group(all P<0.05).Multivariate logistic regression analysis showed that balloon-assisted hemostasis(odds ratio 0.234,95%confidence interval 0.056-0.990;P=0.048)and time from IAR to confirmed hemostasis≤10 min(odds ratio 0.097,95%confidence interval 0.024-0.397;P=0.001)were the independent protective factors of the good outcomes in patients with IAR.Conclusion Using balloon-assisted technique to treat IAR during intracranial aneurysm coil embolization can achieve satisfactory hemostatic effect and improve the clinical outcomes of patients.