摘要
目的 比较多支架重叠辅助弹簧圈栓塞与单纯应用血流导向装置(FD)治疗颅内未破裂椎-基底动脉干动脉瘤(uiVBTA)的安全性及疗效.方法 回顾性分析哈尔滨医科大学附属第一医院神经外科2015年1月至2022年7月收治的105例uiVBTA患者的临床资料,根据治疗方法分为多支架重叠辅助弹簧圈栓塞组(多支架组,65例,共68个动脉瘤)和单纯应用FD治疗组(FD组,40例,共42个动脉瘤),通过数字减影血管造影(DSA)、头颅CT或MRI检查,评估动脉瘤的完全闭塞、满意闭塞及术后神经系统并发症情况;采用改良Rankin量表评分(mRS)评估患者的治疗效果;比较两组患者术后并发症及治疗效果.结果 两组支架或FD均成功置入.两组患者术前基线资料的差异均无统计学意义(均P>0.05).有9.5%(10/105)的患者发生围手术期并发症,其中多支架组为7.7%(5/65),FD组为12.5%(5/40).所有患者均行临床随访,随访时间[M(Q1,Q3)]为28(11,52)个月,末次随访显示,多支架组、FD组的术后并发症的发生率分别为10.8%(7/65)、7.5%(3/40);病死率分别为6.2%(4/65)、7.5%(3/40);预后良好率(mRS≤2分)分别为90.8%(59/65)、90.0%(36/40),差异均无统计学意义(均P>0.05).共59例患者(61个动脉瘤)获得影像学随访,随访时间[M(Q1,Q3)]为8(6,12)个月,末次随访显示,多支架组、FD组动脉瘤完全闭塞率分别为88.9%(32/36)、64.0%(16/25),差异具有统计学意义(P=0.020);动脉瘤满意闭塞率分别为91.7%(33/36)、88.0%(22/25),差异无统计学意义(P=0.971).结论 与单纯FD治疗相比,多支架重叠辅助弹簧圈栓塞治疗uiVBTA的完全闭塞率更高,未观察到两组满意闭塞率及术后并发症的发生率存在差异,两组均具有较高的安全性和有效性,但均应警惕致死性并发症的发生.
Objective To compare the safety and efficacy of overlapping stents-assisted coil embolization and flow diversion(FD)alone for the treatment of unruptured intracranial vertebrobasilar trunk aneurysm(uiVBTA).Methods A retrospective study was conducted on the clinical data of 105 patients with uiVBTA who were treated with overlapping stents-assisted coil embolization or FD alone from January 2015 to July 2022 at the Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University.According to the treatment methods,all patients were divided into the overlapping stents-assisted coil embolization group(multi-stent group,65 patients,68 aneurysms)and flow diversion(FD)alone group(FD group,40 patients,42 aneurysms).The aneurysmal complete occlusion,adequate occlusion and postprocedural neurological complications were evaluated by digital subtraction angiography(DSA)and head CT or MRI.The modified Rankin Scale(mRS)was used to evaluate the clinical outcomes of the patients.Postprocedural complications and therapeutic effects were compared between the two groups.Results The implantations were successful in both groups.There was no statistically significant difference between the two groups in baseline characteristics(all P>0.05).Periprocedural complications occurred in 10 patients(10/105,9.5%),including 5 patients(5/65,7.7%)in the multi-stent group and 5 patients(5/40,12.5%)in the FD group.All patients obtained clinical follow-up,with the median follow-up time of[M(Qi,Q,)]28(11,52)months.The last follow-up showed that the complication rate in the multi-stent group and FD group was 10.8%(7/65)and 7.5%(3/40),respectively;the mortality rate was 6.2%(4/65)and 7.5%(3/40),respectively;the percentage of favorable outcome rate(mRS≤2 scores)was 90.8%(59/65)and 90.0%(36/40),respectively.The differences were not statistically significant(all P>0.05).A total of 59 patients(61 aneurysms)received imaging follow-up,and the follow-up time[M(Qi,Q3)]was 8(6,12) months.The last follow-up showed that the rate of complete aneurysm occlusion was 88.9%(32/36)in the multi-stent group and 64.0%(16/25)in the FD group,and the difference was statistically significant(P=0.020).The adequate occlusion rate was 91.7%(33/36)in the multi-stent group and 88.0%(22/25)in the FD group,with no statistical difference(P=0.971).Conclusions Overlapping stents-assisted coil embolization in the treatment of uiVBTA appears to have a higher complete occlusion rate compared with FD treatment.No difference has been observed in terms of the rate of adequate occlusion and postprocedural complication.Both groups have high safety and efficacy,while the occurrence of fatal complications remains to be noted.
作者
吴桥伟
徐善才
王春雷
吴培
季智勇
亓敬涛
陈爱霞
姚金彪
史怀璋
Wu Qiaowei;Xu Shancai;Wang Chunlei;Wu Pei;Ji Zhiyong;Qi Jingtao;Chen Aixia;Yao Jinbiao;Shi Huaizhang(Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2023年第5期440-445,共6页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(82071309)。
关键词
颅内动脉瘤
血管内操作
对比研究
弹簧圈栓塞
血流导向装置
椎-基底动脉
Intracranial aneurysm
Endovascular procedures
Comparativestudy
Coil embolization
Flow diverter
Vertebrobasilar artery
