两种支架辅助弹簧圈栓塞治疗颅内破裂宽颈动脉瘤的疗效及预后对比

Efficacy and prognosis of two stent-assisted coil embolization in the treatment of ruptured intracranial wide-necked aneurysms

目的观察两种不同支架辅助弹簧圈栓塞(CE)治疗颅内破裂宽颈动脉瘤(IWA)的疗效及预后。方法选取巴中市中心医院108例颅内破裂IWA患者,按随机数字表法分为LVIS组(54例,LVIS支架辅助CE治疗)、Enterprise组(54例,Enterprise支架辅助CE治疗),比较2组栓塞效果、脑血管反应性(CVR)、预后情况以及术后并发症与IWA复发情况。结果2组患者术后即刻栓塞率比较无统计学差异(P>0.05),但LVIS组术后6个月栓塞率高于Enterprise组(P<0.05);治疗后2组屏气后动脉平均血流流速及屏气指数均有提高,但组间对比无统计学差异(P>0.05);治疗后2组患者改良Rankin量表、日常生活活动能力量表评分均有所提高,但组间对比无统计学差异(P>0.05);术后6个月内LVIS组并发症发生率3.70%,Enterprise组为9.26%,2组相比无统计学差异(P>0.05);LVIS组IWA复发率(0)低于Enterprise组(7.41%),差异有统计学意义(P<0.05)。结论LVIS支架、Enterprise支架辅助CE治疗颅内破裂IWA近期疗效相当,预后良好,但LVIS支架辅助治疗远期疗效更佳,复发率更低。

Objective To observe the efficacy and prognosis of two different stent-assisted coil embolization(CE)in the treatment of ruptured intracranial wide-necked aneurysms(IWA).Methods Totally 108 patients with ruptured IWA were selected and divided into LVIS group(n=54,LVIS stent-assisted CE therapy)and Enterprise group(n=54,Enterprise stent-assisted CE therapy)according to the random number table method.The embolization effect,cerebrovascular reactivity(CVR),prognosis,postoperative complications and recurrence of IWA were compared between the two groups.Results The embolization rate immediately after surgery was not significantly different between both groups(P>0.05),but the embolization rate at 6 months after surgery in LVIS group was higher than that in Enterprise group(P<0.05).After treatment,the mean arterial flow velocity and breath-holding index after breath-holding in both groups were increased,but there were no differences between both groups(P>0.05).The scores of modified Rankin scale and activity of daily living scale in the two groups were improved after treatment,but there were no differences between the two groups(P>0.05).The total incidence rate of complications was 3.70%in LVIS group and 9.26%in Enterprise group within 6 months after surgery(P>0.05).The recurrence rate of IWA in LVIS group was 0,which was lower than 7.41%in Enterprise group(P<0.05).Conclusion LVIS stent-and Enterprise stent-assisted CE have similar short-term efficacy and good prognosis in the treatment of ruptured IWA,but LVIS stent-assisted therapy has better long-term efficacy and lower recurrence rate.