Pipeline栓塞装置与支架辅助弹簧圈栓塞治疗大型脑动脉瘤的临床疗效比较

Comparison of Clinical Efficacy between Pipeline Embolization Device and Stent Assisted Coil Embolization in the Treatment of Large Cerebral Aneurysms

【目的】探讨Pipeline栓塞装置(PED)与支架辅助弹簧圈置入(SAC)治疗大型脑动脉瘤的临床疗效。【方法】回顾性分析2017年12月至2021年12月本院收治的82例动脉瘤直径≥10 mm的颅内动脉瘤患者的临床资料,其中43例患者行PED治疗(PED组),39例患者行SAC治疗(SAC组)。比较两组患者手术结果,对比两组术后即刻数字减影血管造影(DSA)检查结果及入院、出院时改良Rankin量表(mRS)评分。两组患者均术后随访12个月,比较两组出院6个月、12个月死亡、复发情况及DSA检查结果及mRS评分分布情况。【结果】本次研究中82例患者均成功完成手术,其中PED组置入PED 45例,单纯PED置入16例,PED结合弹簧圈填塞25例,双枚PED置入2例。两组术后即刻DSA检查结果致密栓塞率比较,差异无统计学意义(P>0.05)。两组入院、出院时mRS评分分布情况比较,差异无统计学意义(P>0.05)。两组围术期并发症发生率及病死率比较,差异无统计学意义(P>0.05)。出院6个月、12个月复查时,PED组致密栓塞率均高于SAC组,差异均有统计学意义(均P<0.05)。PED组出院6个月、12个月返院复查的mRS评分≤2分占比高于SAC组,差异均有统计学意义(均P<0.05)。【结论】PED治疗大型颅内动脉瘤临床疗效及短期预后与SAC相当,但在长期预后改善方面PED表现出一定的优势。

【Objective】To explore the clinical efficacy of Pipeline embolization device(PED)and stent assisted coil placement(SAC)in the treatment of large cerebral aneurysms.【Methods】A retrospective analysis was conducted on the clinical data of 82 patients with intracranial aneurysms with a diameter of≥10 mm admitted to our hospital from December 2017 to December 2021.Among them,43 patients received PED treatment(PED group)and 39 patients received SAC treatment(SAC group).We compared the surgical results of two groups of patients,and compared the results of immediate digital subtraction angiography(DSA)and modified Rankin Scale(mRS)scores at admission and discharge between the two groups.Two groups of patients were followed up 12 months after surgery,and the mortality,recurrence,DSA examination results,and mRS score distribution were compared between the two groups at 6 and 12 months after discharge.【Results】In this study,82 patients successfully completed surgery,including 45 PEDs implanted in the PED group,16 pure PEDs implanted,25 PEDs combined with spring coil filling,and 2 double PEDs implanted.There was no statistically significant difference in the dense embolism rate between the two groups of immediate postoperative DSA examination results(P>0.05).There was no statistically significant difference in the distribution of mRS scores between the two groups at admission and discharge(P>0.05).There was no statistically significant difference in the incidence and mortality of perioperative complications between the two groups(P>0.05).At the 6-12 month follow-up after discharge,the dense embolism rate in the PED group was higher than that in the SAC group,and the differences were statistically significant(all P<0.05).The proportion of mRS scores≤2 in the PED group for follow-up at 6 and 12 months after discharge was higher than that in the SAC group,and the differences were statistically significant(all P<0.05).【Conclusion】The clinical efficacy and short-term prognosis of PED treatment for large intracranial aneurysms are comparable to those of SAC,but PED shows certain advantages in improving long-term prognosis.