颅内大型或巨大型动脉瘤经自膨支架辅助弹簧圈栓塞的效果观察

Observation on the effect of self-expanding stent-assisted coil embolization for large or giant intracranial aneurysms

目的探讨颅内大型或巨大型动脉瘤经自膨支架辅助弹簧圈栓塞与单纯弹簧圈栓塞治疗的效果。方法回顾性选取2018年1月至2021年12月广元市中心医院收治的180例颅内大型或巨大型动脉瘤患者作为研究对象,按照治疗方法不同分为联合组(n=98)和对照组(n=82)。联合组患者采用自膨支架辅助弹簧圈栓塞治疗,对照组患者采用单纯弹簧圈栓塞治疗。比较两组患者的动脉瘤栓塞效果、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力(ADL)评分、改良Rankin量表(mRS)评分及患者的手术并发症和复发率情况。结果治疗后即刻,联合组的Raymond分级中Ⅰ级、Ⅱ级、Ⅲ级患者占比分别为58.16%、32.56%、9.18%,对照组Ⅰ级、Ⅱ级、Ⅲ级患者占比分别为40.24%、43.90%、15.85%,联合组栓塞效果优于对照组,差异有统计学意义(P<0.05)。治疗后1、3个月,联合组的NIHSS评分分别为(16.20±2.89)、(11.08±1.77)分,低于对照组[(18.18±3.14)、(11.77±2.14)分],ADL评分分别为(71.3±5.8)、(78.9±6.4)分,高于对照组[(68.4±6.6)、(74.7±7.0)分],差异均有统计学意义(P<0.05)。联合组患者的并发症发生率与对照组比较(4.08%vs.3.66%),差异无统计学意义(P>0.05)。治疗3个月后,联合组mRS分级优于对照组,差异有统计学意义(P<0.05)。对两组患者进行24个月的随访,联合组患者的复发率8.16%,低于对照组(18.29%),差异有统计学意义(P<0.05)。联合组的无复发时间长于对照组,差异有统计学意义(P<0.05)。结论自膨支架辅助弹簧圈栓塞治疗颅内大型或巨大型动脉瘤患者较单纯弹簧圈栓塞能更有效地栓塞动脉瘤,术后神经功能恢复效果更好,且可降低远期复发率。

Objective To investigate the effect of self-expanding stent-assisted coil embolization and simple coil embolization in the treatment of large or giant intracranial aneurysms.Methods A total of 180 patients with large or giant intracranial aneurysms admitted to Guangyuan Central Hospital from January 2018 to December 2021 were retrospectively selected as the research objects.According to different treatment methods,they were divided into the combined group(n=98)and the control group(n=82).Patients in the combined group were treated with self-expanding stent-assisted coil embolization,and patients in the control group were treated with simple coil embolization.The aneurysm embolization effect,National Institute of Health stroke scale(NIHSS)score,activities of daily living(ADL)score,modified Rankin scale(mRS)score,surgical complications and recurrence rate of the two groups of patients were compared.Results Immediately after treatment,the proportion of patients with Raymond gradeⅠ,Ⅱ,Ⅲin the combined group was 58.16%,32.56%,and 9.18%,respectively.The proportion of patients with gradeⅠ,Ⅱ,Ⅲin the control group was 40.24%,43.90%,and 15.85%,respectively.The embolization effect of the combined group was better than that of the control group,and the difference was statistically significant(P<0.05).At 1 and 3 months after treatment,the NIHSS scores of the combined group were(16.20±2.89)and(11.08±1.77)points,respectively,which were lower than those of the control group[(18.18±3.14)and(11.77±2.14)points],and the ADL scores were(71.3±5.8)and(78.9±6.4)points,respectively,which were higher than those of the control group[(68.4±6.6)and(74.7±7.0)points],the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the combined group and the control group(4.08%vs.3.66%)(P>0.05).After 3 months of treatment,neurological function recovery was evaluated according to the mRS grading standard.Overall,the neurological function prognosis recovery of the combined group was better than that of the control group,and the difference was statistically significant(P<0.05).The patients were followed up for 24 months,and the recurrence rate of the combined group was 8.16%,which was lower than that of the control group(18.29%).The difference was statistically significant(P<0.05).The time of no recurrence in the combined group was longer than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Self expanding stent assisted spring coil embolization is more effective in embolization of large or giant intracranial aneurysms than simple spring coil embolization,with better postoperative neurological function recovery and reduced long-term recurrence rate.