血流导向装置一期治疗颅内多发动脉瘤的临床分析

目的 探讨血流导向装置一期治疗颅内多发动脉瘤的安全性及疗效。方法 回顾性分析连续纳入的2019年1月-2021年4月在郑州大学附属郑州中心医院行Pipeline flex血流导向装置(Pipeline flex embolization device,PED)治疗的有2个及2个以上动脉瘤患者的临床资料,记录其围手术期并发症,评估动脉瘤闭塞情况及临床预后; 动脉瘤闭塞情况采用O'Kelly-Marotta(OKM)分级评估,临床预后采用改良Rankin量表(Modified Rankin scale,mRS)评价。结果 14例患者共32个动脉瘤,均一期行PED治疗; 1例破裂串联动脉瘤患者联合弹簧圈栓塞,术中出现支架内血栓形成,给予替罗非班注射液动脉灌注后恢复血流,术后出现载瘤动脉供血区梗死,术后2周动脉瘤再次破裂出血死亡; 13例未破裂动脉瘤患者均采用单纯PED治疗,围手术期均未出现明显并发症; 随访术后脑血管造影(Digital subtraction angiography,DSA)检查12例患者共27个动脉瘤,中位随访10个月(6～20个月),动脉瘤完全闭塞率74.1%(20/27),支架内无症状性再狭窄1例; 临床随访13例患者,中位随访12个月(6～30个月),均预后良好(mRS 0～2分)。结论 血流导向装置一期治疗未破裂多发性动脉瘤是安全、有效的,但仍需进一步大样本研究。

One-stage treatment of multiple intracranial aneurysms with flow diversion

ObjectiveTo investigate the safety and outcome of one-stage flow diversion in the treatment of multiple intracranial aneurysms.Methods Patients with two or more aneurysms who underwent Pipeline Flex flow diversion device(PED)in Zhengzhou Central Hospital Affiliated to Zhengzhou University from May 2019 to October 2021 were included. Perioperative complications, aneurysms occlusion status and outcomes of the patients were retrospectively analyzed. O'Kelly-Marotta(OKM)classification was used to evaluate aneurysm occlusion, and the modified Rankin Scale(mRS)was used to evaluate the clinical outcomes of patients.Results A total of 14 patients with a total of 32 aneurysms were treated with PED in one stage. One patient with ruptured tandem aneurysm underwent PED combined with coil embolization. Fortunately stent thrombosis occurred during the operation. The aneurysm ruptured again and the patient died 2 weeks later. All 13 patients with unruptured aneurysms were treated with PED alone. DSA imaging followed up 12 patients with 27 aneurysms. The median follow-up was 10 months(6～20 months). The complete occlusion rate of the aneurysm was 74.1%(20/27), and there was only 1 case of in-stent asymptomatic restenosis. Clinical follow-up of 13 patients with a median follow-up of 12 months(6～30 months)showed good prognosis(mRS 0～2 points).Conclusion One-stage treatment of unruptured multiple aneurysms with flow diversion is safe and effective, but further studies with large samples are needed.