Pipeline血流导向装置治疗复发颅内动脉瘤的临床效果分析

目的探讨Pipeline血流导向装置(PED)治疗复发颅内动脉瘤的疗效。方法回顾性分析2016年1月至2019年4月于首都医科大学附属北京天坛医院神经介入中心采用PED治疗的14例复发颅内动脉瘤患者的临床资料。14例患者中,仅行PED治疗10例,PED联合弹簧圈治疗4例。所有患者均行临床随访,采用改良Rankin量表评分(mRS)评估患者的预后;行影像学随访[数字减影血管造影(DSA)]评估颅内动脉瘤的栓塞情况。结果14例患者共成功置入15枚PED。所有PED均到位良好。术后即刻DSA检查显示动脉瘤内血流滞留,载瘤动脉的分支血管均通畅;Dyna CT检查显示支架均准确覆盖瘤颈,贴壁良好。术后2例患者出现手术并发症,其中1例为脑梗死,经抗血小板聚集等对症治疗后症状改善;另1例发生中脑出血后死亡。除死亡患者外,余13例患者均获临床随访,中位随访时间为26个月(范围为12~48个月),无一例发生脑出血或脑梗死,无新发神经功能缺损症状,末次随访mRS均为0分。11例患者行影像学随访,中位随访时间为6个月(范围为3~16个月),其中完全栓塞8例(包括1例单纯弹簧圈栓塞术后复发、3例开颅夹闭术后复发、3例支架辅助弹簧圈栓塞术后复发以及1例单纯支架置入术后复发的患者),瘤颈残余2例(均为支架辅助弹簧圈栓塞术后复发的患者),瘤体部分显影1例(为支架辅助弹簧圈栓塞术后复发的患者)。结论应用PED进行再治疗的单纯弹簧圈栓塞或开颅夹闭术后复发的动脉瘤患者预后良好,而PED治疗曾行支架置入术的复发动脉瘤的效果仍需进一步验证。

Clinical efficacy of Pipeline embolization device in the treatment of recurrent intracranial aneurysms

Objective To investigate the efficacy and complications of Pipeline embolization device(PED)in the treatment of recurrent intracranial aneurysms.Methods A retrospective analysis was conducted on the clinical data of 14 patients with recurrent intracranial aneurysms who were treated with PED at Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University from January 2016 to April 2019.Of the 14 patients,10 were treated with PED alone,and 4 with PED combined with coils.All patients were followed up,the outcome was evaluated according to the modified Rankin Scale(mRS),and the embolization outcome of aneurysm was evaluated by imaging[digital subtraction angiography(DSA)]follow-up.Results Fifteen PEDs were successfully implanted in 14 patients.All PEDs were positioned in place.DSA examination immediately after the procedure showed that the blood flow in the aneurysms was retained and the branches of the parent vessel were unobstructed.Dyna CT examination showed that the stents covered the neck of the aneurysm accurately and were anchored well.Postprocedural complications occurred in 2 patients,including 1 case of cerebral infarction,which recovered after antiplatelet aggregation therapy,and 1 case died after midbrain hemorrhage.All 13 surviving patients were followed up for a median period of 21.0 months(range:12-48 months).There was no cerebral hemorrhage or cerebral infarction,and no new neurological deficits were reported.The mRS scores of all patients were 0 at the latest follow-up.Eleven patients were followed up for a median of 6 months(range:3-16 months).Complete embolization of aneurysm was achieved in 8 patients,including 1 case of aneurysmal recurrence after coil embolization alone,3 cases of recurrence after surgical clipping,3 cases of recurrence after stent-assisted coil embolization and 1 case of recurrence after stent implantation.Residual of aneurysm neck was reported in 2 cases,both of which had recurrence after stent-assisted coil embolization.Residual of the aneurysm body was reported in 1 case of recurrence after stent-assisted coil embolization.Conclusion The treatment outcome with PED in patients with recurrent aneurysms after coil embolization or surgical clipping seems good,while the efficacy of PED in the treatment of recurrent aneurysms after stent implantation remains to be further verified.