Enterprise支架重建技术治疗椎动脉夹层动脉瘤的效果分析

Effect analysis of Enterprise stent reconstruction technology in the treatment of vertebral artery dissecting aneurysms

目的总结并评估Enterprise支架重建技术治疗椎动脉夹层动脉瘤的安全性和中远期效果。方法回顾性分析2013年5月至2018年5月东南大学医学院第二临床学院(东部战区总医院)神经外科连续收治的63例采用Enterprise支架重建技术治疗的椎动脉夹层动脉瘤患者的临床资料。采用Raymond-Roy分级评估术后即刻动脉瘤栓塞程度,术后3个月复查MR血管成像(MRA),6个月复查DSA,动脉瘤复发即随访时DSA显示动脉瘤对比剂充盈增加。临床随访采用门诊和(或)电话随访,记录改良Rankin量表(mRS)评分以评估患者预后。单因素分析筛选预测因素,并纳入多因素Logistic回归分析中,分析影响围手术期并发症发生及动脉瘤复发的独立危险因素。结果63例患者中,1例第2枚支架置入失败,其中25例(39.7%,25/63)为术后即刻完全栓塞,20例(31.7%,20/63)为次全栓塞,18例(28.6%,18/63)为部分栓塞。57例(90.5%,57/63)患者出院时mRS评分0~2分,6例(9.5%,6/63)患者3~6分,死亡3例(4.8%,3/63)。12例(19.0%,12/63)患者发生治疗相关并发症,患者年龄≥65岁(OR=6.533,95%CI:1.686~25.322,P=0.007)是影响并发症发生的独立危险因素。43例(68.3%,43/63)患者至少接受了1次DSA检查,随访中位时间为7(5,36)个月,其中5例(11.6%,5/43)患者夹层动脉瘤复发,3例(7.0%,3/43)患者接受血管内再治疗。单支架治疗(OR=25.356,95%CI:1.444~445.365,P=0.027)是影响动脉瘤复发的独立危险因素。除去3例在院死亡患者和1例失访患者,59例(93.7%)患者接受了临床随访,随访中位时间为40(18,66)个月,所有患者获得良好预后(mRS评分0~2分),其中3例出院时预后不良(mRS评分3~5分),患者在康复治疗后预后良好。结论Enterprise支架重建技术治疗椎动脉夹层动脉瘤患者的中远期结果安全有效,长期疗效还需要多中心大规模的队列研究进一步验证。

Objective To summarize and evaluate the safety and medium and long-term efficacy of Enterprise stent reconstruction technology in the treatment of vertebral artery dissecting aneurysms.Methods The clinical data of 63 patients with vertebral artery dissecting aneurysm treated with Enterprise stent reconstruction technology from May 2013 to May 2018 were retrospectively analyzed in the Department of Neurosurgery,the Second Clinical College,School of Medicine,Southeast University(the Eastern Theater General Hospital).The Raymond-Roy classification was used to assess the degree of embolization of the aneurysm immediately after surgery.MR angiography(MRA)was reviewed 3 months after the operation,and DSA was reviewed 6 months after the operation.The recurrence of the aneurysm means that the DSA showed an increase in the filling of the aneurysm at follow-up.The clinical follow-up was performed in outpatient and/or telephone follow-up,and the modified Rankin scale(mRS)score was recorded to evaluate the prognosis of the patients.The predictive factors were screened by univariate analysis,and multivariate Logistic regression analysis was included to analyze the independent risk factors influencing perioperative complications and recurrence of aneurysm.Results Among the 63 patients,1 patient failed to place the second stent;25 patients(39.7%,25/63)were completely embolized immediately after surgery;20 patients(31.7%,20/63)achieved subtotal embolization,and 18 patients(28.6%,18/63)had partial embolism.Fifty-seven patients(90.5%,57/63)had an mRS score of 0 to 2 at discharge;6 patients(9.5%,6/63)had a score of 3 to 6,and 3 patients died(4.8%,3/63).A total of 12 patients(19.0%,12/63)had treatment-related complications,and age≥65 years old(OR,6.533,95%CI 1.686-25.322,P=0.007)was an independent risk factor for complications.Forty-three patients(68.3%,43/63)received at least one DSA follow-up,with a median follow-up time of 7(5,36)months.Among them,5 patients(11.6%,5/43)had recurrent aneurysm,and 3 patients(7.0%,3/43)received further endovascular retreatment.Single stent(OR,25.356,95%CI 1.444-445.365,P=0.027)is an independent risk factor of aneurysm recurrence.Excluding 3 patients who died in the hospital and 1 patient who was lost to follow-up,59 patients(93.7%)received clinical follow-up,with the median follow-up time of 40(18,66)months.All 59 patients had a good prognosis(mRS 0-2 points).Among them,3 patients with poor prognosis at discharge(mRS score 3-5 points)had good prognosis after rehabilitation treatment.Conclusions The medium and long-term results of Enterprise stent reconstruction technology for the treatment of vertebral artery dissecting aneurysms are safe and effective.The long-term efficacy needs to be further verified by a multi-center large-scale cohort study.