pipeline栓塞装置治疗大脑中动脉动脉瘤的疗效:一项回顾性多中心研究

Clinical efficacy of pipeline embolization devices for patients with middle cerebral artery aneurysms:a retrospective multicenter study

目的 探讨pipeline栓塞装置(PED)治疗大脑中动脉(MCA)动脉瘤的临床效果。方法 回顾性分析2014年11月至2019年10月我国14个临床中心采用PED治疗的33例MCA动脉瘤的临床资料、影像学资料和随访资料。结果 33例共39个动脉瘤,使用37个PED。33例完成临床随访,30例(36个动脉瘤)完成影像随访;随访时间4~22个月,平均(10.6±6.3)个月;动脉瘤完全或近全闭塞30个(83.3%,30/36);相对于单纯PED治疗组(71.4%),PED辅助弹簧圈栓塞组动脉瘤闭塞率更高(100%;P=0.031);预后不良(m RS评分>2分)3例(9.1%),预后良好(mRS评分≤2分)30例(90.9%);术后并发症发生率为24.2%(8/33),术前规律服用双抗药物3 d以上病人术后并发症发生率明显低于未规律服用双抗药物的病人(P=0.033)。结论 MCA动脉瘤可以采用PED治疗,疗效较满意。对于直径大、形态不规则的MCA动脉瘤,可使用PED结合弹簧圈栓塞治疗以获得更高的闭塞率。术前、术后应规范应用双抗药物以减少缺血、出血并发症。

Objective To investigate the clinical efficacy of pipeline embolization devices(PED)for patients with middle cerebral artery(MCA)aneurysms.Methods The clinical data,imaging data and follow-up data of 33 patients with MCA aneurysms treated with PED in 14 clinical centers from November 2014 to October 2019 were retrospectively analyzed.Results Thirty-seven PEDs were used in 33 patients with 39 MCA aneurysms.Clinical follow-up was completed in 33 patients and imaging follow-up was completed in 30 patients(36 aneurysms).The follow-up time ranged from 4 to 22 months,with an average of(10.6±6.3)months.Complete or near complete occlusion of aneurysms were achieved in 30 aneurysms(83.3%,30/36).Compared with the patients treated with PED alone[71.4%(15/21)],the occlusion rate of aneurysms was significantly higher in the patients treated with PED-assisted coil embolization[100%(15/15);P=0.031].Thirty patients(90.9%)had good prognoses(mRS score≤2),and 3(9.1%)had poor prognoses(mRS score>2).The incidence of postoperative complications was 24.2%(8/33),and patients who received dual antiplatelet therapy for more than 3 days before surgery had a significantly lower incidence of postoperative complications(3.4%)compared to those who did not(50%;P=0.033).Conclusions MCA aneurysms can be treated with PED and the effectiveness is good.For MCA aneurysms with large diameter and irregular morphology,PED combined with coil embolization can obtain a higher occlusion rate.Preoperative and postoperative dual antiplatelet therapies are recommended to decrease ischemia and bleeding complications.