破裂与未破裂宽颈动脉瘤支架辅助栓塞治疗疗效分析

摘要

Objective To assess the safety and efficacy of stent-assisted coil embolization for acutely ruptured wide-necked intracranial aneurysms. Methods We retrospectively reviewed 192 wide-necked intracranial aneurysms in 178 patients. The efficacy and peri-procedure complications of stent-assisted embolization were compared between rup⁃ture aneurysms and unrupture aneurysms. Results Stent was successfully implanted in 78 rupture aneurysms and 114 un⁃rupture aneurysms. There was statistically significant difference between rupture aneurysms and unrupture aneurysms groups in rate of poor prognosis on discharge ( 23.1%vs. 5%,χ2=12.726, P<0.001) but not in the peri-procedure compli⁃cations rate (14.1%vs. 6.1%,χ2=3.456,P>0.05)nor in the rate of mortality and permanent disability (8.9%vs. 6.1%,χ2=0.475, P>0.05). Angiograms at 14.7 months of follow-up did not reveal any significant difference between rupture aneu⁃rysms and unrupture aneurysms groups in aneurysm complete occlusion (74.1%vs. 70.6%,χ2=0.197,P>0.05), recana⁃lization (10.3%vs. 9.4%,χ2=0.034,P>0.05)and in-stent stenosis (3.4%vs. 4.7%,χ2=0.136,P>0.05). Conclusion Stent-assisted coil embolization for acutely rupture wide-necked intracranial aneurysms can prevent recurrence effective⁃ly and can achieve high complete occlusion rate in long term follow-up. However, its procedure related complications and mortality is higher in rupture aneurysms than in unrupture aneurysms, which indicates that a caution is needed to conduct stent-assisted coil embolization in rupture aneurysms.%目的：探讨颅内破裂宽颈动脉瘤急性期支架辅助栓塞治疗的有效性和安全性。方法回顾连续纳入178例患者192个宽颈动脉瘤，对比分析支架辅助栓塞宽颈破裂和未破裂动脉瘤的疗效。结果破裂动脉瘤78个，未破裂动脉瘤114个，支架植入成功率100%，破裂动脉瘤组与未破裂动脉瘤组手术相关并发症分别14.1%和6.1%（χ2=3.456，P＞0.05），死亡和永久致残发生率分别8.9%和6.1%（χ2=0.475，P＞0.05），差异无统计学意义。出院时破裂动脉瘤患者发生不良预后明显较未破裂动脉瘤患者常见（23.1%vs.5%，χ2=12.726，P＜0.001）。平均随访14.7个月，脑血管造影复查破裂动脉瘤组和未破裂动脉瘤组动脉瘤完全闭塞率分别74.1%和70.6%（χ2=0.197，P＞0.05）；动脉瘤复发率分别10.3%和9.4%（χ2=0.034，P＞0.05）；支架内血管狭窄发生率分别3.4%和4.7%（χ2=0.136，P＞0.05）；差异无统计学意义。结论破裂宽颈动脉瘤急性期支架辅助栓塞治疗，长期随访动脉瘤完全闭塞率、动脉瘤再通率及支架内血管狭窄率与未破裂动脉瘤结果相近。但是，破裂动脉瘤患者发生不良预后较为常见，手术相关并发症有较未破裂动脉瘤患者高的倾向，因此仍需慎用。