Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的长期预后分析

目的研究Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤的长期预后。方法回顾性分析收治的2011年1月至2015年12月100例颈内动脉眼动脉段动脉瘤患者的临床和影像学资料,总结研究Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤患者的长期预后。结果 100例患者中,共计104个颈内动脉眼动脉段动脉瘤,其中77个小动脉瘤(直径≤15mm),27个大动脉瘤(直径15mm至≤25mm)。根据颈内动脉眼动脉段动脉瘤的分类,36个动脉瘤属眼动脉瘤(Ⅰ型),68个动脉瘤属垂体上动脉动脉瘤(Ⅱ型)。94%患者完成临床随访平均随访时间(28.89±17.63)个月],随访患者中97.8%患者远期预后良好(m RS 0~2分);82%患者完成影像学随访平均随访时间(12.34±7.69)个月],其中7个动脉瘤出现颈部残留,4个动脉瘤复发再通。手术并发症发生率为8.0%,血栓形成3例、弹簧圈脱出2例、血管痉挛2例、动脉瘤破裂出血1例。单因素回归分析提示动脉瘤大小(P=0.000)与动脉瘤不完全栓塞相关;多因素回归分析提示动脉瘤不完全栓塞(P=0.038)与动脉瘤复发相关。结论 Enterprise支架辅助弹簧圈栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,动脉瘤体积越大难以完全栓塞,复发率相对更高。

A Long-term Clinical and Radiographic Outcome of Carotid-ophthalmic Aneurysm with Enterprise Stent-assisted Coiling Embolization

Aim To research the outcome of Enterprise stent-assisted coiling embolization for carotid-ophthalmic aneurysm. Methods From January 2011 to December 2015,100 consecutive patients with 104 carotid-ophthalmic aneurysms were treated with Enterprise stent-assisted embolization. The clinical and radiographic outcomes of those patients were respectively reviewed. Results Of those 104 carotid-ophthalmic aneurysms, there were 77 small aneurysms, 27 large aneurysms and no aneurysm larger than 25 mm. According to aneurysm classification, 36 aneurysms were ophthalmic aneurysm (typeⅠ) and 68 aneurysms belonged to superior artery aneurysm (typeⅡ). 94% patients have achieved clinical fellow-up, which showed good outcome (mRS 0-2) was achieved in 97.8% patients at the last fellow-up and 82%patients attained radiographic fellow-up, and 7 aneurysms were neck recurrence and 4 aneurysms were recanalized at last follow-up. The complication rate was 8.0%, including thromb embolism in three patients, coil prolapsed in two patients, vasospasm in two patients and intracranial hemorrhage in one patient. According to univariate analysis, the aneurysm size associated with incomplete occlusion (P=0.000) and multivariable analysis demonstrated incomplete occlusion was related to aneurysm recurrence (P=0.038). Conclusion Enterprise stent-assisted coiling embolization was a safe and effective treatment method for carotid-ophthalmic aneurysm. The larger aneurysm was more difficult to embolise completely and had a high rate of aneurysm recurrence.