单纯血流导向装置与其联合弹簧圈栓塞治疗中型未破裂颅内动脉瘤的疗效对比分析

A comparative analysis of the efficacy of using blood flow diverter alone and that combined with coil embolization in the treatment of medium-sized unruptured intracranial aneurysms

目的对比分析单纯血流导向装置(FD)与FD联合弹簧圈栓塞治疗中型未破裂颅内动脉瘤的疗效。方法回顾性分析2015年3月至2020年9月河南省人民医院神经外科采用单纯血流导向装置(FD)或FD联合弹簧圈栓塞治疗的137例中型(直径为5~15 mm)未破裂颅内动脉瘤患者(共155个动脉瘤)的临床资料。根据治疗方式分为FD组(96例)与FD+弹簧圈组(41例)。术后6个月临床随访时采用改良Rankin量表评分(mRS)评价预后(以≤2分为预后良好);术后6个月复查数字减影血管造影(DSA), 采用O′Kelly-Marotta(OKM)分级评估动脉瘤闭塞情况(以C级和D级为满意闭塞)。比较两组患者的基线资料、术后并发症、出院时mRS及随访时动脉瘤的闭塞情况。结果两组患者的性别、年龄等基线资料和动脉瘤特征的差异均无统计学意义(均P>0.05)。137例患者的155个动脉瘤共置入161枚FD。FD+弹簧圈组中, 弹簧圈填塞率[M(Q1, Q3)]为11.5%(10.2%, 15.5%)。FD组与FD+弹簧圈组比较, 出院时mRS 0~2分者占比[99.0%(95/96)对比97.6%(40/41)]和术后并发症发生率[4.2%(4/96)对比7.3%(3/41)]的差异均无统计学意义(均P>0.05)。术后6个月时, 127例患者获得临床随访, 两组患者预后良好者占比的差异无统计学意义[98.9%(88/89)对比100%(38/38), P=0.999]。98例患者的109个动脉瘤获得影像学随访, 中位随访时间为6个月;与FD组比较, FD+弹簧圈组的满意闭塞率较高, 差异有统计学意义[94.1%(32/34)对比74.7%(56/75),χ^(2)=5.69, P=0.017]。结论 FD联合弹簧圈治疗中型未破裂颅内动脉瘤较单纯FD治疗的动脉瘤完全闭塞率高, 且并不增加并发症的发生风险。

Objective To investigate the efficacy of using flow diverter(FD)alone and that combined with coil embolization in the treatment of medium-sized unruptured intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of 137 patients with a total of 155 medium-sized(5-15 mm)unruptured intracranial aneurysms who were treated with FD alone or that combined with coil embolization at the Department of Neurosurgery of Henan Provincial People's Hospital from March 2015 to September 2020.According to the treatment methods,all patients were divided into FD group(96 cases)and FD+coil group(41 cases).The modified Rankin scale(mRS)was used to evaluate the outcome at the 6-month postoperative follow-up(≤2 was considered as favorable outcome).The digital subtraction angiography(DSA)was re-examined 6 months after the operation,and 0'Kelly-Marotta(OKM)grading scale was used to evaluate the outcome of aneurysm occlusion(class C and D as satisfactory occlusion).The baseline data,postoperative complications,mRS at discharge and aneurysm occlusion during follow-up were analyzed and compared between the two groups.Results There were no significant differences in baseline data such as gender,age,and aneurysm characteristics between the two groups(all P>0.05).A total of 161 FDs were implanted in 155 aneurysms in 137 patients.In the FD+coil group,the coil packing density[M(Q,Q3)]was 11.5%(10.2%,15.5%).Compared with the FD+coil group,the.proportion of patients with the mRS of 0-2 points at discharge[99.0%(95/96)us.97.6%(40/41)]and the ineidence of postoperative complications[4.2%(4/96)us.7.3%(3/41)]in the FD group were not statistically significant(both P>0.05).At 6 months post operation,127 patients were followed up,and there was no significant difference in the proportion of patients with favorable outcomes between the two groups[98.9%(88/89)us 100%(38/38),P=0.999].A total of 109 aneurysms of 98 patients were followed up by imaging,and the median follow-up time was 6 months.Compared with the FD group,the satisfactory occlusion rate of the FD+coil group was higher,and the difference was statistically significant[94.1%(32/34)vs.74.7%(56/75),x2=5.69,P=0.017].Conclusion Treatment using FD combined with coils for medium-sized unruptured intracranial aneurysms is associated with a higher rate of complete occlusion of aneurysms compared with that using FD alone,and it does not increase the risk of complications.