不同介入方法治疗颅内大型或巨大型动脉瘤的单中心经验

摘要

Objective To evaluate the clinic efifcacy, complication and prognosis of different interventional modalities in the treatment of large and giant intracranial aneurysms. Methods Between January 2001 and December 2010, 134 patients with large and giant intracranial aneurysms treated by endovascular approaches in the Department of Neurosurgery of Changhai Hospital were retrospectively analyzed. Of the 134 patients, 11 had been treated by parent artery occlusion, 20 by coil embolization, 78 by stent-assisted coil, and the rest 25 patients by Tubridge. Patients were followed up for 6~44 months after the procedure. Angiographic results were evaluated with Raymond grading system, whereas clinical outcomes were evaluated with the modiifed Rankin Scale (mRS). Favorable prognosis rate when discharge, the cure rate, the recurrence rate and favorable prognosis rate when follow-up, complication incidence were compared. Results The rate of favorable prognosis in the parent artery occlusion group was 100%, coil embolization group was 70.0%, stent-assisted coil embolization group was 91%and lfow-diverter device group was 100%;the differences between groups are statistically signiifcant (P=0.0030). At the time of last follow-up, the cure rate of the parent artery occlusion group was 63.6%, coil embolization group was 5.6%, stent-assisted coil embolization group was 37.2%and lfow-diverter device group was 72%;the differences between groups are statistically signiifcant (P=0.0002). At the time of last follow-up, the recurrence rate of the parent artery occlusion group was 0%, coil embolization group was 83.3%, stent-assisted coil embolization group was 30.8%and lfow-diverter device group was 0%;the differences between groups are statistically significant (P<0.0001). The last follow-up favorable prognosis rate of the parent artery occlusion group was 100%, coil embolization group was 75%, stent-assisted coil embolization group was 90%and lfow-diverter device group was 100%;the differences between groups are statistically signiifcant (P=0.0209). The complication incidence of the parent artery occlusion group was 27.3%, coil embolization group was 30%, stent-assisted coil embolization group was 14.1%and lfow-diverter device group was 0%;however, there were no statistical differences in the complication incidence between the four groups (P=0.0650). Conclusion Endovascular treatment of large or giant intracranial aneurysms is very challenging. Coil embolization is often associated with a very high recurrence rate, stent-assisted coil embolization can reduce the recurrence rate, parent artery occlusion gets satisfied favorable prognosis and recurrence rate, but the complication incidence is relatively high, the preliminary clinical results of lfow diverter device appear to be satisfactory.%目的评价不同介入方法治疗颅内大型或巨大型动脉瘤的有效性、并发症发生率以及预后情况。　　方法回顾性分析第二军医大学附属长海医院神经外科自2001年1月～2010年12月采用不同介入方法治疗的134例颅内大型或巨大型动脉瘤患者的临床资料，按患者接受介入治疗方法不同分为4组，其中载瘤动脉闭塞术11例，单纯弹簧圈栓塞20例，支架辅助下弹簧圈栓塞78例，血流导向装置治疗25例，随访时间6～44个月。影像学结果依据改良Raymond评分，临床症状依据改良Rankin量表（modified Rankin Scale，mRS）评分系统评价，分别评价4组患者出院时的预后良好率、末次随访时动脉瘤的治愈率、复发率，预后良好率及手术并发症情况。　　结果载瘤动脉闭塞组出院时的预后良好率是100%，单纯弹簧圈栓塞组为70%，支架辅助弹簧圈组为91%，而血流导向装置组为100%，四组间差异具有显著性（P=0.0030）。载瘤动脉闭塞组末次随访时治愈率是63.6%，单纯弹簧圈栓塞组为5.6%，支架辅助弹簧圈组为37.2%，而血流导向装置组为72%，四组间差异具有显著性（P=0.0002）。载瘤动脉闭塞组末次随访时的复发率为0%，单纯弹簧圈栓塞组为83.3%，支架辅助弹簧圈组为30.8%，而血流导向装置组为0%，四组间差异具有显著性（P＜0.0001）。载瘤动脉闭塞组末次随访时预后良好率为100%，单纯弹簧圈组为75%，支架辅助弹簧圈组为90%，血流导向装置组为100%，四组间差异具有显著性（P=0.0209）。载瘤动脉闭塞组并发症发生率为27.3%，单纯弹簧圈组为30%，支架辅助弹簧圈组为14.1%，血流导向装置组为0%，四组间差异无显著性（P=0.0650）。　　结论在颅内大型或巨大型动脉瘤的介入治疗中，单纯弹簧圈栓塞复发率高，支架辅助弹簧圈栓塞可降低复发率，载瘤动脉闭塞组预后良好率及复发率满意，但并发症发生率偏高，血流导向装置的初步临床结果令人满意。