支架半释放辅助栓塞技术治疗急性颅内破裂微小宽颈动脉瘤的疗效观察

Clinical efficacy of stent semi-release assisted embolization in the treatment of ruptured tiny wide-necked intracranial aneurysms

目的探讨支架半释放辅助栓塞技术治疗急性颅内破裂微小宽颈动脉瘤的安全性及有效性。方法回顾性分析2018年2月至2022年2月邢台市人民医院神经外科收治的急性(动脉瘤破裂至治疗时间间隔≤7 d)颅内破裂微小宽颈动脉瘤(动脉瘤最大直径≤3 mm)患者的临床资料,共102例。均采用支架半释放辅助栓塞技术栓塞动脉瘤。采用Raymond分级标准评估动脉瘤的栓塞效果(Ⅰ级为完全栓塞,Ⅱ级为近完全栓塞,Ⅲ级为部分栓塞),观察手术相关并发症,采用改良Rankin量表评分(mRS)评估患者的临床预后(0~2分为预后良好,≥3分为预后不良)。结果102例患者术前mRS 0分61例(59.8%),1分19例(18.6%),2分9例(8.8%),3分8例(7.9%),4分5例(4.9%)。患者术后即刻造影显示,Raymond分级Ⅰ级栓塞69例(67.7%),Ⅱ级栓塞30例(29.4%),Ⅲ级栓塞3例(2.9%);其中4例(3.9%)发生支架内血栓形成,6例(5.9%)发生载瘤动脉局部狭窄,术后均未遗留神经功能缺损症状。出院后患者随访时间为(7.4±1.4)个月(3~12个月)。末次随访mRS 0分84例(82.4%),1分8例(7.8%),2分6例(5.9%),3分4例(3.9%);与术前mRS比较,差异具有统计学意义(P<0.01)。末次数字减影血管造影评估显示,Raymond分级Ⅰ级栓塞94例(92.2%),Ⅱ级栓塞8例(7.8%),Ⅲ级栓塞0例,与术后即刻分级比较差异有统计学意义(P<0.01);5例动脉瘤复发,复发率为4.9%,随访期均未发生动脉瘤再出血及脑梗死情况。结论支架半释放辅助栓塞技术治疗急性颅内破裂微小宽颈动脉瘤,围手术期并发症发生率低,术后短期疗效较好,复发率低。

Objective To investigate the safety and effectiveness of stent semi-release assisted embolization in the treatment of ruptured tiny wide-necked intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of 102 patients with acute(time interval from aneurysm rupture to treatment≤7 days)ruptured tiny wide-necked intracranial aneurysms(maximum diameter of aneurysm≤3 mm)admitted to the Department of Neurosurgery,Xingtai People′s Hospital from February 2018 to February 2022.All aneurysms were embolized with stent-assisted semi-release embolization technique.The Raymond grading scale was used to evaluate the embolization effect of aneurysms(gradeⅠas complete embolization,gradeⅡas near-complete embolization,and gradeⅢas partial embolization).The procedure-related complications were observed.The modified Rankin scale(mRS)was used to evaluate the clinical outcomes of patients(0-2 as good outcome and≥3 as poor outcome).Results The preoperative mRS of 102 patients was 0 in 61 cases(59.8%),1 in 19 cases(18.6%),2 in 9 cases(8.8%),3 in 8 cases(7.8%),and 4 in 5 cases(4.9%).The operations of 102 patients were successfully performed.Immediate postoperative angiography showed Raymond gradeⅠembolization in 69 cases(67.7%),gradeⅡembolization in 30 cases(29.4%),and gradeⅢembolization in 3 cases(2.9%).Among them,4 cases(3.9%)had stent thrombosis,6 cases(5.9%)had local stenosis of parent artery,and no neurological deficit symptoms were left after operation.All patients were followed up for 3-12 months after discharge,and the follow-up time was 7.4±1.4 months.The mRS at the last follow-up was 0 in 84 cases(82.4%),1 in 6 cases(7.8%),2 in 6 cases(5.9%),and 3 in 4 cases(3.9%).Compared with the preoperative mRS,the difference was statistically significant(P<0.01).The last DSA evaluation of patients showed Raymond gradeⅠembolization in 94 cases(92.2%),gradeⅡembolization in 8 cases(7.8%),and gradeⅢembolization in 0 cases,and the difference was statistically significant compared with the immediate postoperative grading(P<0.01).Aneurysm recurrence occurred in 5 cases,and the recurrence rate was 4.9%.No aneurysm rebleeding or cerebral infarction occurred during the follow-up period.Conclusion Stent semi-release assisted embolization in the treatment of ruptured tiny wide-necked intracranial aneurysms has a low incidence of perioperative complications,a good short-term postoperative effect and a low recurrence rate.