[1]毛立武,王天玉,康玉琪,等.血流导向装置治疗颅内动脉瘤的疗效分析[J].中国临床神经外科杂志,2022,27(06):433-436.[doi:10.13798/j.issn.1009-153X.2022.06.001]
　MAO Li-wu,WANG Tian-yu,KANG Yu-qi,et al.Efficacy and safety of flow diverter for patients with intracranial aneurysm[J].,2022,27(06):433-436.[doi:10.13798/j.issn.1009-153X.2022.06.001]
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血流导向装置治疗颅内动脉瘤的疗效分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年06期
页码:
433-436
栏目:
论著
出版日期:
2022-06-30

文章信息/Info

Title:
Efficacy and safety of flow diverter for patients with intracranial aneurysm
文章编号:
1009-153X(2022)06-0433-04
作者:
毛立武; 王天玉; 康玉琪; 刘俊中; 时伟玉; 郭广涛; 王圣杰
450000 郑州，郑州大学附属郑州中心医院神经介入科（毛立武、王天玉、康玉琪、刘俊中、时伟玉、郭广涛、王圣杰）
Author(s):
MAO Li-wu;  WANG Tian-yu;  KANG Yu-qi;  LIU Jun-zhong;  SHI Wei-yu;  GUO Guang-tao;  WANG Sheng-jie
Department of Neurointerventional Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China
关键词:
颅内动脉瘤; 血管内治疗; 血流导向装置; 疗效
Keywords:
Intracranial aneurysm;  Endovascular treatment;  Flow diverter;  Safety;  Efficacy
分类号:
R743.9;R815.2
DOI:
10.13798/j.issn.1009-153X.2022.06.001
文献标志码:
A
摘要:
目的 探讨血流导向装置治疗颅内动脉瘤的疗效及安全性。方法 回顾性分析2019年5月至2021年4月行Pipeline Flex血流导向装置治疗的53例（68个动脉瘤）的颅内动脉瘤的临床资料。结果 53例68个动脉瘤，共置入60枚PED，技术成功率为100%。40例54个动脉瘤单纯应用PED治疗，术后即刻造影显示动脉瘤内造影剂明显滞留48个，无明显滞留6个；13例（14个动脉瘤）联合应用PED和弹簧圈栓塞，术后即刻造影均致密栓塞。围手术期总并发症发生率为7.5%（4/53）。53例临床随访6~28个月（中位数12个月）；末次随访时，47例未破裂动脉瘤预后良好（mRS评分≤2分）；6例破裂动脉瘤中，预后良好2例，mRS评分3分1例，4分1例，死亡2例。46例DSA随访4~8个月（中位数6个月），动脉瘤完全闭塞率为67.9%。22例（28个动脉瘤）DSA随访9~18个月（中位数12个月），动脉瘤完全闭塞率为85.7%，无动脉瘤复发。结论 血流导向装置治疗颅内动脉瘤总体安全、有效，但对颅内破裂动脉瘤的安全性仍需进一步研究。
Abstract:
Objective To investigate the outcomes of flow diverter for the patients with intracranial aneurysm. Methods The clinical data of 53 patients with intracranial aneurysm who were treated with Pipeline Flex flow diverter from May 2019 to April 2021 were retrospectively analyzed. Perioperative complications were recorded. Neurological prognosis was asessed using modified Rankin scale (mRS) score, with a mRS score≤2 as good prgnosis. Aneurysm occlusion after operation was evaluated using O'Kelly-Marotta grade, with grade D as complete embolization. Results A total of 60 PEDs were implanted in 53 patients with 68 aneurysms, and the technical success rate was 100%. Immediate postoperative angiography showed significant retention of the contrast agent in 48 of 54 aneurysms of 40 patients who were treated with simple PED, and no retention in the other 6 aneurysms. Immediate angiography showed complete embolization was achieved in 14 aneurysms of 13 patients who were treated with PED combined with coil embolization. The total perioperative complication rate was 7.5% (4/53). The clinical follow up of 53 patients (range, 6~28 months; median, 12 months) showed that 47 patients with unruptured aneurysm had good prognosis, 2 patients with ruptured aneurysm had good prognosis, 1 patients with ruptured aneurysm had mRS score of 3, 1 patients with ruptured aneurysm had mRS score of 4, and 2 patients with ruptured aneurysm died. The DSA follow up of 46 patients (range, 4~8 months; median, 6 months) showed a complete occlusion rate of 67.9%. The DSA follow up of 22 patients (range, 9~18 months; median, 12 months) showed a complete occlusion rate of 85.7%, and no recurrence of aneurysm. Conclusions The flow diverter is generally safe and effective for the patients with intracranial aneurysm, but the safety of flow diverter for the ruptured intracranial aneurysms needs further study.

参考文献/References:

[1] Becske T, Brinjikji W, Potts MB, et al. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneury-sms: five-year results of the pipeline for uncoilable or failed aneurysms trial [J]. Neurosurgery, 2017, 80(1): 40-48.
[2] Lylyk I, Scrivano E, Lundquist J, et al. Pipeline embolization devices for the treatment of intracranial aneurysms, single-center registry: long-term angiographic and clinical outcomes from 1000 aneurysms [J]. Neurosurgery, 2021, 89(3): 443-449.
[3] Cagnazzo F, Fanti A, Lefevre PH, et al. Distal anterior cerebral artery aneurysms treated with flow diversion: experience of a large-volume center and systematic review of the literature [J]. J Neurointerv Surg, 2021,13(1): 42-48.
[4] 中国医师协会神经介入专业出血性脑血管病神经介入专业委员会（学组），中国医师协会神经外科分会神经介入专业委员会，中国医师协会介入医师分会神经介入专业委员会. 血流导向装置治疗颅内动脉瘤的中国专家共识[J]. 中华神经外科杂志，2020，36（5）：433-445.
[5] Hanel RA, Cortez GM, Lopes DK, et al. Prospective study on embolization of intracranial aneurysms with the pipeline device (PREMIER study): 3-year results with the application of a flow diverter specific occlusion classification [J]. J Neurointerv Surg, 2022. doi: 10.1136/neurintsurg-2021-018501. Online ahead of print.
[6] Giorgianni A, Agosti E, Molinaro S, et al. Flow diversion for acutely ruptured intracranial aneurysms treatment: a retrospective study and literature review [J]. J Stroke Cerebrovasc Dis, 2022, 31(3): 106284.
[7] 田其，杨锐博，韩守孟，等. Tubridge血流导向装置治疗颅内大型未破动脉瘤[J]. 中国临床神经外科杂志，2021，26（6）：414-418.
[8] Charbonnier G, Desilles JP, Escalard S, et al. Timing and spectrum of neurological complications after flow diverter implantation for intracranial aneurysms [J]. Front Neurol, 2021, 12: 590383.
[9] Hou K, Li G, Lv X, et al. Delayed rupture of intracranial aneurysms after placement of intra-luminal flow diverter [J]. Neuroradiol J, 2020, 33(6): 451-464.
[10] Wang C, Luo B, Li T, et al. Comparison of the pipeline embolisation device alone or combined with coiling for treatment of different sizes of intracranial aneurysms [J].
Stroke Vasc Neurol, 2022. doi: 10.1136/svn-2021-001258. Online ahead of print.
[11] Zhang M, Tian Z, Zhang Y, et al. How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint [J]. J Neurointerv
Surg, 2022. doi: 10.1136/neurintsurg-2021-018361. Online ahead of print.
[12] Wu X, Tian Z, Li W, et al. Patency of branch vessels after pipeline embolization: comparison of various branches [J]. Front Neurol, 2019, 10: 838.
[13] Ravindran K, Salem MM, Enriquez-Marulanda A, et al. Quantitative assessment of in-stent stenosis after pipeline embolization device treatment of intracranial aneurysms: a
single-institution series and systematic review [J]. World Neurosurg, 2018, 120: e1031-e1040.

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备注/Memo

备注/Memo:
（2022-01-13收稿，2022-04-10修回）
通讯作者：王天玉，E-mail：xlhywangtianyu@163.com
更新日期/Last Update: 2022-07-31