摘要
目的评价Pipeline血流导向装置(Pipeline flow diverter,PED)治疗未破裂颈内动脉中小型动脉瘤的安全性及有效性。方法收集2018年1月至2022年2月我院神经介入科采用PED及支架辅助弹簧圈栓塞(stent-assisted coiling,SAC)治疗的53例颈内动脉未破裂动脉瘤患者的临床资料,并进行回顾性分析及组间对比。分别采用O Kelly Marotta(OKM)分级及Raymond分级评估术后即刻及随访时动脉瘤的栓塞程度;采用改良Rankin量表评分(mRS)评价患者围手术期及随访时的神经功能;介入治疗术后3个月开始采用DSA或CTA随访复查动脉瘤的闭塞情况及支架通畅情况。结果共有符合纳入标准患者53例,其中PED 31例,SAC 22例。两组患者性别、年龄等基线数据均无统计学差异。PED组34枚动脉瘤的术后即刻DSA显示造影剂明显滞留,OKM A级9枚(26.4%),B级7枚(20.6%),C级14枚(41.2%),D级4枚(11.8%)。SAC组24枚动脉瘤的术后即刻DSA显示,RaymondⅠ级16枚(66.7%),Ⅱ级7枚(29.1%),Ⅲ级1枚(4.2%)。手术时间在PED组和SAC组之间存在显著统计学差异(P=0.003<0.05),围手术期出现不良事件为9例,PED组4例,SAC组5例,两组之间差异无统计学意义(P=0.49)。PED组术后平均随访时间为(6.4±1.8)个月(范围:5~12个月);SAC组术后平均随访时间为(10.4±9.0)个月(范围:2~30个月)。对术后动脉瘤闭塞情况进行观察,PED组完全闭塞28例(84.8%),SAC组完全闭塞17例(77.3%)。SAC组术后复发4例,PED组未见术后复发。术后随访中所有患者预后良好,mRS≤2,无出血或缺血导致的术后不良事件发生。结论使用PED治疗颈内动脉未破裂中小型动脉瘤可以缩短手术时间,具有不弱于支架辅助栓塞治疗的动脉瘤完全闭塞率及安全性,且在避免术后复发方面具有明显优势,但长期疗效仍需进一步的随访观察。
Objective To evaluate the safety and effectiveness of Pipeline Flow Diverter(PED)in the treatment of unruptured small and medium-sized aneurysms of internal carotid artery.Methods From January 2018 to February 2022,the clinical data of 53 patients with unruptured internal carotid artery aneurysms treated by PED and stent-assisted coil embolization(SAC)in the neurointerventional therapy in the Department of Neurological Intervention in our hospital were collected.Retrospective analysis and comparison between groups were evaluated.O Kelly Marotta(OKM)scale and Raymond scale were used to evaluate the degree of aneurysm embolization immediately after operation and follow-up.The modified Rankin Scale(mRS)was used to evaluate the neurological function of the patients during perioperative period and follow-up.Digital subtraction angiography(DSA)or CT angiography(CTA)were used to evaluate the degree of aneurysm embolization and stent patency during the follow-up.Results A total of 53 patients met the inclusion criteria,including 31 patients treated by PED and 22 patients treated by SAC.There is no significant statistical differences in gender,age and other baseline data between the two groups.The DSA of 34 aneurysms immediately after the operation of PED group showed that the cantrast agent was well filled in the aneurysms.The OKM grades were grade A in 9(26.4%)cases,grade B in 7(20.6%),grade C in 14(41.2%),and grade D in 4(11.8%).24 aneurysms immediately after the operation of SAC group showed that the Raymond grades were grade I in 16(66.7%)cases,gradeⅡin 7(29.1%),gradeⅢin 1(4.2%).However there was a significant statistical difference in operation time between the PED group and SAC group(P=0.003<0.05).There are 9 cases of perioperative complications,4 cases in PED group and 5 cases in SAC group.There is no statistically significant difference between the two groups(P=0.49).The mean follow-up time of PED group was(6.4±1.8)months(range:5~12 months)and SAC group was(10.4±9.0)months(range:2~30 months).The postoperative degree of aneurysm occlusion was observed,28 cases(84.8%)in PED group and 17 cases(77.3%)in SAC group were completely occluded.But there are 4 postoperative recurrence cases in the SAC group and 0 in the PED group.In postoperative follow-up,all patients have a good prognosis,with mRS≤2,and no adverse events caused by bleeding or ischemia occurred.Conclusions The use of PED neuro-interventional therapy of small and medium-sized aneurysms of internal carotid artery shows less operation time and no less rate of complete aneurysm occlusion and safety than SAC therapy.It has obvious advantage in avoiding postoperative recurrence,but long-term efficacy still needs further follow-up observation.
作者
矫健
李汶翰
罗瀚
袁亚君
王文毫
刘汉伟
于本帅
Jian Jiao;Wenhan Li;Han Luo;Yajun Yuan;Wenhao Wang;Hanwei Liu;Benshuai Yu(Department of Neurological Intervention,Interventional Medical Centre,the Fifth Affiliated Hospital of Sun Yat-sen University,Guangdong Zhuhai 519000;Department of Imaging Diagnostic,Yuebei People's Hospital,Guangdong Shaoguan 512026,China)
出处
《中华介入放射学电子杂志》
2023年第3期223-229,共7页
Chinese Journal of Interventional Radiology：electronic edition
作者简介
通信作者:于本帅,Email:yubenshuai@163.com。
