LVIS支架辅助治疗颈内动脉-后交通动脉(ICA-PcoA)动脉瘤的回顾性分析

Retrospective analysis of LVIS stent-assisted treatment of internal carotid artery-posterior communicating artery(ICA-PcoA)aneurysms

目的探究LVIS支架辅助弹簧圈栓塞术治疗颈内动脉-后交通动脉(ICA-PcoA)动脉瘤的临床效果。方法回顾性分析2016年3月—2020年3月收治的ICA-PcoA动脉瘤患者210例,均行支架辅助弹簧圈栓塞术,根据支架不同分为3组:70例采用LVIS支架(LVIS组),70例采用Solitare支架(Solitare组),70例采用Enterprise支架(Enterprise组)。根据数字减影血管造影(DSA)结果和Raymond标准评估支架的辅助栓塞效果,采用改良Rankin量表(mRS)、日常生活活动能力量表(BI指数)评价预后,并观察手术并发症发生率及动脉瘤复发率。结果LVIS组、Solitare组和Enterprise组支架置入成功率差异无统计学意义(χ^(2)=1.032,P=0.479),Raymond分级显示,LVIS组术后即刻及术后6个月动脉瘤栓塞效果优于Solitare组和Enterprise组(均P<0.05);LVIS组术后6个月,mRS 0~2分患者所占比例、BI指数评分均高于Solitare组和Enterprise组(均P<0.05);LVIS组手术并发症发生率及动脉瘤复发率均低于Solitare组和Enterprise组,无统计学意义(均P>0.05)。结论LVIS支架辅助栓塞治疗对ICA-PcoA动脉瘤的栓塞效果好,安全性高,复发率低,但要注意术中血栓形成和术后载瘤动脉狭窄。

Objective To explore the clinical effect of LVIS stent-assisted coil embolization on internal carotid artery-posterior communicating artery(ICA-PcoA)aneurysms.Methods A total of 210 patients with ICA-PcoA aneurysms admitted to our hospital and receiving stent-assisted coil embolization from March 2016 to March 2020 were divided into three groups according to different stents.Patients in the LVIS group(70 cases)were given LVIS stents,patients in the Solitare group(70 cases)were given Solitare stents,and patients in the Enterprise group(70 cases)were given Enterprise stents.The effect of stent-assisted embolization was assessed by digital subtraction angiography(DSA)and Raymond criteria.Prognostic effect was assessed using the Modified Rankin Scale(mRS)and the Activity of Daily Living Scale(BI index).The incidence rate of surgical complications and the rate of recurrence of aneurysms were recorded.Results There was no significant difference in the success rate of stent placement among the three groups(χ^(2)=1.032,P=0.479).The Raymond grading showed that the embolization effect of aneurysms in the LVIS group was better than those in the Solidare group and the Enterprise group immediately after surgery and 6 months after surgery(all P<0.05).The percentage of patients with 0-2 points of mRS score and BI index in the LVIS group were higher than those in the Solitare group and the Enterprise group after 6 months of surgery(all P<0.05).The incidence rate of surgical complications and recurrence rate of aneurysms in the LVIS group were lower than those in the Solitare group and the Enterprise group,but there was no significant difference(all P>0.05).Conclusion LVIS stent-assisted embolization has a good embolization effect on ICA-PcoA aneurysms,with high safety and low recurrence rate,but attention should be paid to intraoperative thrombosis and postoperative parent artery stenosis.