血流导向装置在后循环夹层动脉瘤的应用

Application of flow diverter in treating posterior circulation dissecting aneurysms

目的分析血流导向装置(FD)治疗后循环夹层动脉瘤的安全性和有效性。方法回顾性分析2014年1月至2020年12月郑州大学第一附属医院采用FD治疗的59例颅内后循环夹层动脉瘤患者临床资料。根据动脉瘤位置将患者分为椎动脉组(n=33)和基底动脉组(n=26),根据应用FD数分为单FD和多FD治疗。采用O’Kelly-Marotta(OKM)分级评估DSA影像,改良Rankin量表(mRS)评分评估患者临床预后。结果59例患者手术技术成功率为100%,共植入75枚FD(椎动脉组42枚,基底动脉组33枚)。围手术期发生缺血性并发症7例(11.9%),出血性并发症2例(3.4%),术后病死3例(5.1%)。43例患者随访6(2~19)个月,完全愈合率为69.8%(30例),预后良好率为97.7%(42例)。椎动脉组、基底动脉组分别随访6.5(2~17)个月、6(3~19)个月,完全愈合率分别为70.8%、68.4%(均P>0.05),预后良好率分别为100%、94.7%(均P>0.05)。结论FD治疗椎动脉夹层动脉瘤相对安全有效,治疗基底动脉夹层动脉瘤的缺血性并发症发生率相对较高,多FD应用于基底动脉夹层动脉瘤可能增加缺血性并发症发生率和病死率。

Objective To evaluate the safety and effectiveness of flow diverter(FD)in treating posterior circulation dissecting aneurysms.Methods The clinical data of 59 patients with intracranial posterior circulation dissecting aneurysm,who were treated with flow diverter between January 2014 and December 2020 at the First Affiliated Hospital of Zhengzhou University of China,were retrospectively analyzed.According to the location of the aneurysm,the patients were divided into vertebral artery group(n=33)and basilar artery group(n=26).Based on the number of used FD,the patients were divided into single-FD therapy group and multiple-FD therapy group.O’Kelly-Marotta(OKM)grading scale was used to evaluate DSA images,and the modified Rankin scale(mRS)was used to assess the clinical prognosis of patients.Results The technical success rate of 59 patients was 100%.A total of 75 FD stents were implanted,including 42 FD stents in the vertebral artery group and 33 FD stents in the basilar artery group.Perioperative ischemic complications occurred in 7 patients(11.86%),hemorrhagic complications in 2 patients(3.4%),and death in 2 patients(5.1%).Forty-three patients were followed up for a median time of 6 months(2-19 months),the complete cure rate was 69.8%(n=30),and the good prognosis rate was 97.7%(n=42).The patients of vertebral artery group and basilar artery group were followed up for 6.5 months(2-17 months)and 6 months(3-19 months)respectively,their complete cure rates were 70.8%and 68.4%respectively(P>0.05),and the good prognosis rates were 100%and 94.74%respectively(P>0.05).Conclusion For the treatment of dissecting aneurysms of vertebral artery,FD is relatively safe and effective.For the treatment of dissecting aneurysms of basilar artery,FD carries relative high incidence of ischemic complications.In treating dissecting aneurysms of basilar artery,the use of multiple FD stents may increase the incidence of ischemic complications and the mortality.