Pipeline栓塞装置治疗非颈内动脉瘤的安全性和短期效果分析

Safety and short-term efficacy of Pipeline embolization device in the treatment of non-cervical aneurysms

目的评价Pipeline栓塞装置(PED)治疗非颈内动脉瘤(大脑前动脉、前交通动脉、大脑中动脉和椎-基底动脉部位的动脉瘤)相对于颈内动脉瘤的安全性和短期效果。方法回顾性分析2015年1月至2020年2月于郑州大学第一附属医院神经介入科采用PED治疗颅内动脉瘤患者的临床资料。根据动脉瘤的部位将患者分为颈内动脉瘤组和非颈内动脉瘤组,分析比较两组患者围手术期并发症(出血、缺血并发症)发生情况和短期随访结果。所有患者采用PED置入治疗,术后6个月进行DSA随访,采用Raymond-Roy分级评估动脉瘤闭塞效果(完全闭合、近似闭合、未愈合及好转,好转为完全闭合和近似闭合)。结果共纳入125例患者(127个动脉瘤)行PED介入治疗,PED置入成功率为100.0%;其中颈内动脉瘤组87例(89个动脉瘤),非颈内动脉瘤组38例[38个动脉瘤,其中大脑前动脉5例(A1段1例,A2段3例,A3段1例)、大脑中动脉15例(M1段14例、M2段1例)、前交通动脉3例、椎动脉V4段10例、基底动脉5例]。颈内动脉瘤组与非颈内动脉瘤组患者围手术期出血[3.4%(3/89)比0]、缺血并发症发生率[3.4%(3/89)比2.6%(1/38)]差异均无统计学意义(P值分别为0.554、1.000)。共有68例患者(共68个动脉瘤)进行了DSA随访检查,包括颈内动脉组50例,非颈内动脉组18例;其中51个动脉瘤完全闭合,动脉瘤闭合率为75.0%(51/68)。两组短期随访中的动脉瘤完全闭合率[80.0%(40/50)比11/18,P=0.204])及好转率[92.0%(46/50)比14/18,P=0.238])差异均无统计学意义。结论与颈内动脉瘤组相比,PED治疗非颈内动脉瘤(大脑前动脉、大脑中动脉、前交通动脉和椎-基底动脉部位的动脉瘤)不增加围手术期并发症的发生率,对促进动脉瘤愈合同样安全且有效。

Objective To investigate the safety and short-term efficacy of Pipeline embolization devices(PED)in the treatment of non-cervical aneurysms(aneurysms in anterior cerebral artery,anterior communicating artery,middle cerebral artery and vertebrobasilar artery).Methods A retrospective analysis was conducted on the clinical data of patients with intracranial aneurysms who were treated with PED at the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from January 2015 to February 2020.According to the location of the aneurysms,the patients were divided into the cervical aneurysm group and the non-cervical aneurysm group.The incidence of perioperative complications(hemorrhagic and ischemic complications)and short-term follow-up results of the two groups were analyzed and compared.All patients were treated with PED implantation,followed up by DSA 6 months after surgery.The effect of aneurysm occlusion(complete closure,approximate closure,not closure and improvement[including complete closure and approximate closure])was evaluated by Raymond-Roy grading.Results A total of 127 aneurysms were detected in 125 patients,and the success rate of PED implantation was 100.0%.The cervical aneurysm group had 87 cases(89 aneurysms)and the non-cervical aneurysm group had 38 cases(38 aneurysms,among them anterior cerebral artery in 5 cases[A1 segment 1 case,A2 segment 3 cases,A3 segment 1 case],middle cerebral artery in 15 cases[M1 segment 14 cases,M2 segment 1 case],anterior communicating artery in 3 cases,vertebral artery V4 segment in 10 cases and basilar artery in 5 cases).There were no significant difference in the postoperative bleeding rate(3.4%[3/89]vs.0%,P=0.554)and ischemia rate(3.4%[3/89]vs.2.6%[1/38],P=1.000).DSA follow-up was performed in 68 patients(68 aneurysms),including 50 in the cervical aneurysm group and 18 in the non-cervical aneurysm group.The follow-up results showed that 51 aneurysms were completely closed with a obliteration rate of 75.0%(51/68)and there was no statistically difference in the complete aneurysm obliteration rate(80.0%[40/50]vs.11/18,P=0.204)and improvement rate(92.0%[46/50]vs.14/18,P=0.238)between the two groups during short-term follow-up.Conclusion Compared with cervical aneurysm group,PED in the treatment of non-cervical aneurysms located in the anterior cerebral artery,anterior communicating artery,middle cerebral artery and vertebrobasilar artery did not increase the incidence of postoperative complications,and was also safe and effective in promoting aneurysm occlusion.