Pipeline血流导向装置治疗颅内大型和巨大型夹层动脉瘤的疗效分析:多中心回顾性研究

Clinical efficacy of pipeline emoblization device for treatment of large and giant intracranial dissecting aneurysms:a multicenter retrospective analysis

目的明确Pipeline血流导向装置(PED)治疗颅内大型和巨大型夹层动脉瘤的安全性和有效性.方法回顾性分析2014年11月至2019年10月首都医科大学附属北京天坛医院等14家临床中心进行的PLUS研究中的临床和影像学资料,提取其中接受PED治疗的颅内大型(最大直径为15~<25 mm)和巨大型(最大直径为≥25 mm)未破裂夹层动脉瘤患者的数据,总结其临床特征和治疗情况.术后即刻动脉瘤的闭塞程度采用O'Kelly-Marotta(OKM)分级进行评价,治疗结局通过临床随访获得的改良Rankin量表评分(mRS)以及影像学随访结果评估.结果研究纳入36例患者(36个动脉瘤),共置入44枚PED.仅使用PED治疗18例(50.0%),PED结合弹簧圈栓塞治疗18例(50.0%);使用多枚PED治疗7例(19.4%).支架贴壁良好率为100.0%(44/44),支架调整后的释放成功率为88.9%(32/36).术后即刻造影结果显示,OKM分级A级20例(55.6%),B级12例(33.3%),C级3例(8.3%),D级1例(2.8%).围手术期1例(2.8%)患者出现缺血性并发症,1例(2.8%)死亡.35例患者完成临床随访,28例完成影像学随访.随访时间为(11.7±5.3)个月(3~24个月).末次随访时,86.1%(31/36)的患者神经功能恢复良好(mRS为0~1分).OKM分级为D级的比率为92.9%(26/28),1例动脉瘤复发.总的并发症发生率为11.1%(4/36),总病死率为5.6%(2/36).结论使用PED治疗颅内大型和巨大型夹层动脉瘤安全、有效,短中期随访可以观察到良好的临床结局.

Objective To examine the efficacy and safety of pipeline embolization devices(PED)for the treatment of large and giant intracranial dissecting aneurysms.Methods Clinical and imaging data of patients who were treated with PED in 14 clinical centers including Beijing Tiantan Hospital Affiliated to Capital Medical University from November 2014 to October 2019 were collected for retrospective analysis.Patients who were diagnosed with large(15-<25 mm)or giant unruptured dissecting aneurysms(≥25 mm)were extracted from the medical records,and clinical characteristics and treatment exposure were summarized.Immediate aneurysm occlusion rates were assessed using the O′Kelly-Marotta grading scale(OKM)and treatment outcome of patients were evaluated using imaging results and modified Rankin Scale(mRS)scores at clinical follow-up.Results A total of 36 aneurysms in 36 patients were treated and 44 PEDs were successfully placed.The patients treated with PED alone or PED combined with coil embolization accounted for 50.0%(18/36)each,and 7 patients(19.4%)underwent surgery using two or more stents.All stents(100.0%,44/44)had good wall adherence while the rate of successfully deployment after adjustment was 88.9%(32/36).Immediate postprocedural angiography indicated OKM grade A in 20 patients(55.6%),grade B in 12(33.3%),grade C in 3(8.3%)and grade D in 1(2.8%).Among 36 patients,1(2.8%)had peri-procedural ischemic complication and 1(2.8%)died.Clinical follow-up was completed in the remaining 35 patients and imaging follow-up in 28 patients(36 aneurysms).The follow-up time ranged from 3 to 24 months,with an average of 11.7±5.3 months.A total of 31 patients(86.1%)had good neurological recovery(mRS score:0-1).The OKM grade D rate was 92.9%(26/28).1 case had recurrence.The overall complication rate and mortality rate were 11.1%(4/36)and 5.6%(2/36)respectively.Conclusion PED may be an efficient and safe treatment for large and giant dissecting aneurysms and good clinical outcomes can be achieved after short-term or medium-term treatment.