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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2017, Vol. 03 ›› Issue (06) : 335 -342. doi: 10.3877/cma.j.issn.2095-9141.2017.06.004

所属专题： 文献；

临床研究

支架辅助弹簧圈栓塞颅内宽颈破裂动脉瘤的疗效分析
王晓东1,†(), 秦兆为1   
  1. 1. 515300　广东普宁，普宁市人民医院神经外科
  • 收稿日期:2017-07-03 出版日期:2017-12-15
  • 通信作者: 王晓东
  • 基金资助:
    "十三五"重点课题(2016YFC0901003)

Stent-assisted embolization of acutely rupture wide-necked intracranial aneurysms: complication and efficacy

Xiaodong Wang1,†(), Zhaowei Qin1   

  1. 1. Department of Neurosurgery, Puning People’s Hospital, Puning 515300, Guangdong Province, China
  • Received:2017-07-03 Published:2017-12-15
  • Corresponding author: Xiaodong Wang
  • About author:
    Corresponding author: Wang Xiaodong, Email:
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王晓东, 秦兆为. 支架辅助弹簧圈栓塞颅内宽颈破裂动脉瘤的疗效分析[J]. 中华神经创伤外科电子杂志, 2017, 03(06): 335-342.

Xiaodong Wang, Zhaowei Qin. Stent-assisted embolization of acutely rupture wide-necked intracranial aneurysms: complication and efficacy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2017, 03(06): 335-342.

目的

评估单中心支架辅助弹簧圈栓塞颅内宽颈破裂动脉瘤的安全有效性和长期随访的疗效。

方法

回顾性分析普宁市人民医院神经外科自2011年1月至2015年12月行支架辅助栓塞颅内宽颈破裂动脉瘤的52例患者的临床及影像学资料。主要搜集的资料包括：患者年龄、性别、高血压、Hunt-Hess分级、mFisher分级、支架类型、支架置入时机、影像学结果、并发症情况和长期随访结果；利用单因素分析和多因素分析的方法探讨影响围手术期并发症的因素。

结果

在52例患者中，围手术期相关并发症发生率9.615%（5例），包括：术中出血1例、术后出血1例，术后脑梗3例。Logistic回归分析高级别Hunt-Hess分级[比值比（OR）=18.09，95%可信区间（95%CI）：1.03~316.61，P=0.047]、高级别mFisher分级（OR=10.25，95%CI：1.41~75.52，P=0.021）是预测手术相关并发症的独立因素。在得到了临床随访结果的40例患者中[随访率76.9%，（22.1±4.5）个月]，37例患者有较好的临床疗效（mRS 0分）。影像学随访的患者39例，其中4例出现动脉瘤复发。

结论

支架辅助栓塞破裂宽颈动脉瘤是可行的治疗方案之一，其并发症率在可接受范围内。Hunt-Hess分级和mFisher分级是预测手术相关并发症的独立因素。

关键词: 宽颈颅内动脉瘤, 支架辅助栓塞, 破裂
Objective

To evaluate the safety and angiographic and clinical outcome of stent-assisted coil placement for acutely ruptured wide-necked intracranial aneurysms treated in a single center.

Methods

A total of 52 rupture wide-necked aneurysms that were treated with stent-assisted coiling from January 2011 to December 2015 were reviewed retrospectively at our institution. Data collected and analyzed included: patient demographics; morphologic features of the aneurysm; treatment results and follow-up results.

Results

There were 5 (9.6%) overall procedure-related complications in 52 patients, including: 1 intraprocedural aneurysm ruptures, 1 postoperative hemorrhage, 2 thromboembolic complications. In a logistic regression analysis, the complications differed significantly in the patients with high Hunt-Hess grade (OR=18.09, 95%CI: 1.03-316.61, P=0.047), high mFisher grade (OR=10.25, 95%CI: 1.41-75.51, P=0.021). Favorable outcomes were seen in 37 of those patients in along-term follow-up.

Conclusion

Stent-assisted coiling of ruptured wide-necked intracranial aneurysms is effective, and provides durable aneurysm closure. High Hunt-Hess grade and mFisher grade is association with significantly higher complication rates.

Key words: Wide-necked Intracranial aneurysms, Stent-assisted embolization, Rupture
表1 手术相关并发症的单因素分析[例（%）]
变量 所有病例(n=52) 并发症组(n=5) 无并发症组(n=47) t/χ2值 P值
年龄（岁，均数±标准差） 55.142±9.576 62.628±1.954 54.328±9.745 1.901 0.064
男性 15(28.846) 0(0) 15(31.914) 0.060 0.831
高血压 5(9.615) 4(80) 1(2.128) 7.921 0.015
动脉瘤部位 ? ? ? 0.388 0.473
? 前循环 47(90.384) 4(80) 43(91.489) ? ?
? 后循环 5(9.616) 1(20) 4(8.511) ? ?
动脉瘤大小 ? ? ? 5.122 0.095
? 小（直径 18(34.615) 4(80) 14(29.787) ? ?
? 中（直径5~10 mm） 27(51.923) 1(20) 26(55.319) ? ?
? 大（直径>10 mm） 7(13.462) 0(0) 7(14.894) ? ?
使用支架类型 ? ? ? 1.660 0.424
? Enterprise 32(61.538) 4(80) 28(59.574) ? ?
? Neuroform 12(23.076) 0(0) 12(25.531) ? ?
? Solitaire 8(15.386) 1(20) 7(14.895) ? ?
先置入支架 44(84.615) 2(40) 42(89.361) 8.459 0.022
Hunt-Hess分级 ? ? ? 15.191 0.002
? 高级别 9(17.307) 4(80) 5(10.638) ? ?
? 低级别 43(82.693) 1(20) 42(89.262) ? ?
mFisher分级 ? ? ? 7.045 0.031
? 高级别 9(17.307) 3(60) 6(12.765) ? ?
? 低级别 43(82.693) 2(40) 41(87.235) ? ?
表2 手术相关并发症的多因素分析
变量 OR 95%CI P值
Hunt-Hess分级 18.091 1.031~316.614 0.047
mFisher分级 10.257 1.415~74.525 0.021
高血压 3.423 0.208~57.737 0.394
先置入支架 8.706 0.575~133.791 0.121
图1 1例后交通动脉瘤破裂患者支架辅助弹簧圈栓塞后出血的影像资料
图2 1例后交通动脉瘤患者支架辅助弹簧圈栓塞后的影像资料
图3 1例床突段动脉瘤患者支架辅助弹簧圈栓塞后复发的影像资料
表3 影响动脉瘤介入术后复发的因素分析[例（%）]
变量 复发组(n=4) 未复发组(n=35) t/χ2值 P值
年龄（岁，均数±标准差） 61.531±15.426 53.769±9.237 1.912 0.145
男性 0(0) 12(34.285) 1.985 0.292
动脉瘤部位 ? ? 0.66 0.636
? 前循环 4(100) 30(85.714) ? ?
? 后循环 0(0) 5(14.285) ? ?
动脉瘤大小 ? ? 3.084 0.105
? 小（直径 0(0) 14(40) ? ?
? 中（直径10~24 mm） 3(75) 19(54.286) ? ?
? 大（直径>24 mm） 1(25) 2(5.714) ? ?
使用支架类型 ? ? 1.980 0.424
? Enterprise 4(100) 23(65.714) ? ?
? Neuroform 0(0) 7(20) ? ?
? Solitaire 0(0) 5(14.286) ? ?
先置入支架 4(100) 29(82.857) 0.817 0.602
Hunt-Hess分级 ? ? 4.107 0.104
? 高级别 2(50) 4(11.428) ? ?
? 低级别 2(50) 31(88.572) ? ?
mFisher分级 ? ? 0.056 0.991
? 高级别 1(25) 7(20) ? ?
? 低级别 3(75) 28(80) ? ?
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