高分辨率C形臂CT在颅内动脉瘤Pipeline Flex植入术中的价值

The application value of high-resolution C-arm CT in performing Pipeline Flex embolization device implantation for intracranial aneurysms

目的探讨颅内支架专用高分辨率XperCT在颅内动脉瘤Pipeline Flex植入术中的临床价值。方法回顾性分析2019年10月至2020年5月昆明医科大学第一附属医院采用Pipeline Flex植入术治疗的12例患者颅内动脉瘤患者临床资料。对比分析二维DSA造影、常规颅脑XperCT及颅内支架专用XperCT在显示支架打开情况、支架与动脉瘤位置、支架与血管贴壁情况方面的差异。3名10年以上神经介入医师对图像质量进行量化评分。术后3个月患者随访复查,O’Kelly-Marotta(OKM)分级评价动脉瘤瘤腔闭塞情况,同时记录相关并发症。结果 12例患者(15枚动脉瘤)共植入12枚Pipeline Flex。颅内支架专用高分辨率XperCT在显示支架打开情况方面显著优于二维DSA造影(P=0.007),在显示支架与血管贴壁情况方面显著优于二维DSA造影(P=0.001)和常规颅脑XperCT(P=0.003)。12例患者获平均4.7个月(3~6个月)随访。术后3个月DSA造影复查显示患者OKM分级为A级0例,B级2例(16.7%),C级4例(33.3%),D级6例(50.0%),均未出现相关并发症;术后4.7个月瘤腔完全栓塞率为50.0%(6/12)。结论颅内支架专用高分辨率XperCT在显示支架贴壁情况方面具有独特优势。术后常规行颅内支架专用高分辨率XperCT,可即刻显示支架打开及贴壁情况。

Objective To explore the clinical value of high-resolution XperCT, that is specifically used for intracranial stenting, in performing Pipeline Flex embolization device implantation for intracranial aneurysms. Methods The clinical data of 12 patients with intracranial aneurysm, who were admitted to the First Affiliated Hospital of Kunming Medical University of China to receive Pipeline Flex embolization device implantation between October 2019 and May 2020, were retrospectively analyzed. The displaying clearness degrees of the stent opening status, the location of stent and aneurysm,and the attaching status of stent to vascular wall were compared between each other among the two-dimensional digital subtraction angiography(DSA), conventional craniocerebral XperCT and specific high-resolution XperCT. Three experienced physicians who engaged in clinical neurointervention for more than 10 years made quantitative scoring of the image quality. Follow-up check-up was carried out 3 months after treatment in all patients, O’Kelly-Marotta(OKM) classification was used to evaluate the occlusion of aneurysm cavity, and the procedure-related complications were recorded. Results A total of 12 Pipeline Flex embolization devices were implanted in 12 patients(15 aneurysms in total). In displaying the stent opening status, high-resolution XperCT specifically used for intracranial stenting was remarkably better than two-dimensional DSA(P=0.007);and in displaying the attaching status of stent to vascular wall, high-resolution XperCT specifically used for intracranial stenting was significantly superior to both two-dimensional DSA(P=0.001) and conventional craniocerebral XperCT(P=0.003).Twelve patients were followed up for a mean period of 4.7 months(3-6 months). DSA reexamination performed at 3-month follow-up showed that OKM of grade A was obtained in 0 patient, OKM of grade B in 2 patients(16.7%), OKM of grade C in 4 patients(33.3%) and OKM of grade D in 6 patients(50.0%). No procedurerelated complications occurred. The complete embolization rate of aneurysm cavity at 4.7 months after operation was 50.0%(6/12). Conclusion In displaying the attaching status of stent to vascular wall, highresolution XperCT specifically used for intracranial stenting carries unique advantage. Postoperative routine performance of high-resolution XperCT scan can promptly display the stent opening status and the attaching status of stent to vascular wall.