Pipeline血流导向装置治疗颅内前循环复杂动脉瘤的中长期疗效

目的探讨Pipeline血流导向装置(PED)治疗颅内前循环复杂动脉瘤的中、长期疗效.方法回顾性分析新疆医科大学第一附属医院神经外科2015年5月至2018年9月应用PED治疗的58例颅内前循环动脉瘤患者的临床资料.其中动脉瘤未破裂者50例,破裂者8例.采用0'Kelly-Marotta(OKM)分级标准评估动脉瘤的闭塞程度,采用改良Rankin量表评分(mRS)评价患者的临床预后.结果58例患者均成功置入支架.术后即刻血管造影显示8例(13.8%)动脉瘤完全闭塞(OKM分级D级).术后分别于4~9(5.8±1.1)个月、10~18(12.8±2.1)个月及24~52(33.9±8.3)个月行短、中及长期随访.3个时期动脉瘤的完全闭塞率分别为87.7%(50/57)、98.2%(55/56)及100.0%(47/47),临床预后良好(mRS 0~2分)率分别为96.6%(56/58)、98.2%(55/56)及97.9%(46/47).58例患者中,术后13例(22.4%)发生并发症,2例(3.4%)死亡.其中出血性并发症2例(3.4%),脑积水1例(1.7%),无症状性分支血管闭塞4例(6.9%),视力下降2例(1例永久性失明),穿刺点血肿3例、上消化道出血1例.8例破裂动脉瘤患者,短、中及长期随访动脉瘤的完全闭塞比例分别为5/7、6/6及5/5;4例发生并发症,其中出血性并发症2例、梗阻性脑积水1例、视力下降1例,4例中死亡2例.结论PED治疗颅内前循环复杂动脉瘤严重并发症的发生率低;中、长期随访动脉瘤完全闭塞率高.破裂动脉瘤并发症发生比例较高,需慎重选择行PED治疗.

Operative managements of extracranial carotid artery aneurysms: a report of three cases and literature review

Background:The purpose of this study is to report the treatment approaches and postoperative outcomes of extracranial carotid artery aneurysms (ECAAs) and discuss the symptoms,related risk factors,etiology,diagnostic methods,treatments,and follow-up period complications.Case presentation:We describe three patients with symptomatic extracranial carotid artery aneurysms;one of them was treated with end-to-end anastomosis of the extracranial internal carotid artery (EICA) after the resection of the aneurysm,while the other two patients were deployed with Willis covered stents in the extracranial internal carotid artery.All of the patients were in good condition when discharged home.After a mean follow-up period of 8 months,all the patients were alive and only one of them had the neurologic deficit.Additionally,we reviewed the relative literatures.Conclusion:Both of the surgical and endovascular treatments have relatively satisfactory outcomes in ECAA patients.However,it is necessary to provide individualized treatments to different patients according to the characteristics of the aneurysms.