LVIS支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤预后影响因素分析

Prognostic Factors Analysis of LVIS Stent-Assisted Coil Embolization for Acute Ruptured Wide-Necked Intracranial Aneurysms

目的探讨LVIS支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的疗效,分析预后影响因素。方法回顾性分析2015年2月至2020年2月行LVIS支架辅助弹簧圈栓塞治疗的60例急性期颅内破裂宽颈动脉瘤患者的临床资料,术后根据mRs评分评估预后,分析预后影响因素。结果60例急性期颅内破裂宽颈动脉瘤患者手术均获成功,支架手术成功率为100%;术中出现动脉瘤破裂1例(1.67%),载瘤动脉血栓形成3例(5%)。术后造影检查显示动脉瘤完全栓塞52例(86.67%),近全栓塞6例(10%),部分栓塞2例(3.33%),栓塞率为96.67%(58/60)。单因素分析显示,年龄、原发性高血压史、入院时Hunt-Hess分级以及动脉瘤分型可能是影响急性颅内破裂宽颈动脉瘤预后的危险因素(P<0.05);二元Logistic回归分析显示入院时Hunt-Hess分级为Ⅲ~Ⅳ级是影响预后的独立危险因素(P<0.05)。结论LVIS支架辅助弹簧圈栓塞治疗急性期颅内破裂颈动脉瘤效果显著,安全性高;对于入院时Hunt-Hess分级为Ⅲ~Ⅳ级者应提高警惕,在病情允许下尽快实施手术治疗,以改善预后。

Objective To explore the effect and prognostic factors of LVIS stent-assisted coil embolization in the treatment of acute ruptured wide-necked intracranial aneurysms.Methods The clinical data of 60 patients with acute ruptured wide-necked intracranial aneurysms treated by LVIS stent-assisted coil embolization from February 2015 to February 2020 were selected to analyze retrospectively.The prognosis was evaluated according mRs score after the operation,and the risk factors of prognosis were analyzed by univariate and multivariate analysis.Results The surgical intervention was accomplished successfully in all 60 patients with 100%of stent success rate.Aneurysm rupture occurred in one case(1.67%)and aneurysmal sacs thrombosis in 3 cases(5%)during the operation.Postoperative angiography showed that the aneurysm was completely embolized in 52 cases(86.67%),subtotal embolized in 6 cases(10%)and partially embolized in 2 cases(3.33%),and the embolization rate was 96.67%(58/60).Univariate analysis showed that the prognosis of acute ruptured wide-necked intracranial aneurysms cases performed LVIS stent-assisted coil embolization was related with the age,primary hypertension history,Hunt-Hess classification and aneurysm type of admission(P<0.05).Binary logistic regression analysis revealed that the Hunt-Hess grade of admission was the independent risk factor of the prognosis of acute rupture wide-necked intracranial aneurysm(P<0.05).Conclusions The LVIS stent-assisted coil embolization is reliable and safe for acute ruptured wide-necked intracranial aneurysm.In view of the prognostic risk factor,the patients with high Hunt-Hess grade(ⅢtoⅣ)should be paid more attention and carried out surgical intervention as soon as possible to improve the prognosis.