Lvis支架辅助弹簧圈栓塞治疗未破裂宽颈颅内动脉瘤及对神经功能、血流动力学的影响

Lvis stent-assisted coil embolization in the treatment of unruptured wide-necked intracranial aneurysms and its effects on neurofunction and hemodynamics

目的研究Lvis支架辅助弹簧圈栓塞(CE)治疗未破裂宽颈颅内动脉瘤(uWNIAs)及对神经功能、血流动力学的影响。方法选择2015年5月至2020年4月我院收治的uWNIAs患者86例,依照已接受双支架或单支架辅助栓塞情况将86例患者分为双支架组(n=43)与单支架组(n=43)。单支架组行单Lvis支架辅助CE治疗,双支架组行双Lvis支架辅助CE治疗。观察两组术后即刻及术后6个月动脉瘤栓塞程度,术前、术后6个月神经功能及病侧与健侧局部脑血容量(rCBV)、局部脑血流量(rCBF)、达峰时间(TTP)及平均通过时间(MTT)等脑血流动力学指标的绝对灌注比值,并发症及复发情况。结果术后即刻,两组动脉瘤栓塞程度差异无统计学意义(P>0.05)。术后6个月,双支架组动脉瘤栓塞程度优于单支架组(P<0.05),ADL评分及rCBV、rCBF比值均大于单支架组,神经功能缺损程度评分及TTP、MTT比值均小于单支架组(P<0.05)。两组并发症发生率差异无统计学意义(P>0.05),双支架组复发率小于单支架组(P<0.05)。结论单、双支架辅助CE治疗uWNIAs均可达到栓塞的目的,但双支架辅助治疗更有助于改善患者神经功能、血流动力学,降低复发率,且不增加并发症发生率。

Objective To investigate Lvis stent-assisted coil embolization(CE)in the treatment of unruptured wide-necked intracranial aneurysms(uWNIAs)and its effects on neurofunction and hemodynamics.Methods Eighty-six uWNIAs patients admitted to our hospital from May 2015 to April 2020 were selected.The patients were divided into a double stent group and a single stent group according to whether patients accepted double stent-assisted or singlestent-assisted CE,43 in each group.The single stent group was given single stent-assisted CE treatment while the double stent group was given double stent-assisted CE treatment.The embolization degree of intracranial aneurysms was observed immediately after operation and after 6 months of operation.Neurological function,absolute perfusion ratio of cerebral hemodynamic indicators such as regional cerebral blood volume(rCBV),regional cerebral blood flow(rCBF),time-to-peak(TTP)and mean transit time(MTT)on the diseased side and the healthy side,complications and recurrence were also observed before and after 6 months of operation.Results Immediately after operation,there was no significant difference in intracranial aneurysms(IAs)embolization degree between the two groups(P>0.05).After 6 months of operation,the IAs embolization degree in the double stent group were significantly higher than that in the single stent group(P<0.05).Activity of daily living(ADL)scores,rCBV and rCBF ratio in the double stent group were significantly higher than those in the single stent group while neurological function deficit(NFD)scores,TTP and MTT ratio in the double stent group were significantly lower than those in the single stent group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The incidence of recurrence in the double stent group was significantly lower than that in the single stent group(P<0.05).Conclusion Single and double stent-assisted CE therapy for uWNIAs can achieve the purpose of embolization.However,double stent-assisted therapy is more helpful to improve the neurofunction and hemodynamics,reduces the recurrence rate,and does not increase the incidence of complicationsof the patients.