颅内动脉瘤支架植入术后新生内膜增生临床研究

Clinical study of neointimal hyperplasia after stent implantation for intracranial aneurysms

目的 探讨颅内动脉瘤支架植入术后新生内膜增生(NIH)变化及其影响因素。方法 收集2018年10月至2020年10月在昆明医科大学第一附属医院接受支架辅助弹簧圈栓塞(SACE)或血流导向装置(FD)治疗的42例颅内前循环动脉瘤患者临床资料。分析治疗后支架NIH状况及影响因素。两名高年资神经介入医师根据血管造影图像,测量并记录患者术后即刻、术后随访复查时支架段最狭窄处、颈内动脉岩段直径,并计算每幅图像比率(T值,支架段直径/岩段颈内动脉直径)。结果 T值变化呈由大至小再由小变大的动态过程,远期随访10~15个月(中位12.5个月)T值已基本恢复至术后即刻水平。单因素分析结果显示年龄、动脉瘤长径是患者中期NIH的影响因素。多因素logistic回归分析显示年龄是中期NIH发生的预测因子(OR=0.903,95%CI=0.828~0.984,P=0.020),患者年龄越大治疗后出现NIH的可能性越小。结论 颅内动脉瘤支架植入术后NIH变化是一逐渐加重、逐渐减轻的动态过程,远期随访时支架段血管直径基本恢复至术后即刻水平。年龄、动脉瘤大小是患者中期NIH影响因素,年龄是独立保护因素。

Objective To explore the changes of neointimal hyperplasia(NIH) after stent implantation for intracranial aneurysms,and to discuss the factors affecting NIH.Methods The clinical data of 42 patients with anterior circulation intracranial aneurysms,who were treated with stent-assisted coil embolization(SACE) or flow diverter(FD) at the First Affiliated Hospital of Kunming Medical University of China between October 2018 and October 2020,were collected.The postoperative NIH status in the stent and the factors affecting NIH were analyzed.The diameter of the narrowest part of the stent segment and the diameter of the petrosal segment of internal carotid artery were measured by two high-senior neurointervention physicians on postoperative instant angiographic images as well as on the follow-up angiographic images,and the ratio of stent segment diameter/internal carotid artery petrosal segment diameter(T-value) of each image was calculated.Results The T-value presented as a dynamic change process,which changed from large to small and then from small to large.Long-term follow-up for 10-15 months(median of 12.5 months) showed that the T-value basically recovered to the postoperative instant level.Univariate analysis indicated that age and aneurysm long diameter were the mid-term influencing factors for NIH.Multivariate logistic regression analysis revealed that age was a protective factor for mid-term NIH(OR=0.903,95%CI=0.828-0.984,P=0.020),indicating that the older the patient was,the lower the likelihood of occurring post-treatment NIH would be.Conclusion The postoperative NIH status after stent implantation for intracranial aneurysms is a dynamic process that gradually aggravates and then gradually alleviates.Long-term follow-up check reveals that the stent segment diameter has basically recovered to the postoperative instant level.The age and aneurysm size are the mid-term influencing factors for NIH,while the age is an independent protective factor for mid-term NIH.(J Intervent Radiol,2022,31:328-332)