血流导向装置治疗复杂颅内动脉瘤的并发症分析

Flow-diverter devices in complex intracranial aneurysm: a complication analysis

目的探讨血流导向装置(FD)治疗复杂颅内动脉瘤的并发症情况。方法连续纳入自2018年7月至2021年6月就诊于桂林医学院第二附属医院脑血管病科并采用FD治疗的60例复杂颅内动脉瘤患者为研究对象,回顾性收集患者的临床及影像资料,并记录其并发症发生情况,包括术中不良事件、术后早期并发症、随访期并发症及覆盖分支动脉闭塞情况等。结果60例患者共植入61枚FD(Pipeline Flex 47枚、Tubridge 10枚、Surpass Streamline 4枚),术中不良事件发生率为8.3%(5/60),其中支架不完全贴壁3例、术中出血1例、支架未覆盖动脉瘤瘤颈1例;术后早期并发症发生率为6.7%(4/60),其中出血性并发症3例、缺血性并发症1例。54例患者完成DSA随访[随访时长为(22.7±16.8)个月],动脉瘤完全治愈率为83.3%(45/54)。术后6个月首次DSA随访时支架内再狭窄发生率为7.4%(4/54),其中2例分别于术后2年、3年进展为载瘤动脉闭塞。54例患者术中FD共覆盖78条分支动脉,末次DSA随访时仅观察到1条(1.3%)分支动脉闭塞,但未引起临床症状。结论FD治疗复杂颅内动脉瘤的并发症不容忽视,术中不良事件以支架贴壁不良为主,出血性并发症集中发生于术后早期,随访期需警惕支架内再狭窄发生。

Objective To evaluate the complications of complex intracranial aneurysms after intervention with flow-diverter(FD)devices.Methods Sixty patients with complex intracranial aneurysms accepted FD devices in Department of Cerebrovascular Diseases,Second Affiliated Hospital of Guilin Medical University from July 2018 to June 2021 were chosen.Clinical and imaging data of these patients were retrospectively analyzed,and complications were recorded:procedure-related adverse events,early postprocedural complications,complications during follow-up,and covered branch occlusion.Results A total of 61 FD devices(47 Pipeline Flex,10 Tubridge,4 Surpass Streamline)were implanted in 60 patients.Incidence of procedure-related adverse events was 8.3%(5/60),including 3 with incomplete stent apposition,1 with intraoperative bleeding,1 with aneurysm neck not covered by stent;incidence of early postprocedural complications was 6.7%(4/60),including 3 with hemorrhagic complication and 1 with ischemic complication.DSA follow-up([22.7±16.8]months)was completed in 54 patients;aneurysm healed rate was 83.3%(45/54).First DSA follow-up 6 months after surgery showed that in-stent restenosis was 7.4%(4/54),of which 2 deteriorated to parent vessel occlusion at 2-and 3-year after procedure,respectively.A total of 78 branch arteries were covered by FD devices,and only 1(1.3%,1/78)demonstrated branch artery occlusion at last follow-up,without clinical symptoms.Conclusion The complications of complex intracranial aneurysms after intervention with FD devices should be recognized;incomplete stent apposition is the main procedure-related adverse event,and hemorrhagic complication mainly appear in the early postprocedural period;in-stent restenosis should be vigilant during follow-up.