Pipeline血流导向装置治疗颅内动脉瘤的安全性及疗效分析

目的探讨Pipeline血流导向装置(PED)治疗颅内动脉瘤的安全性和疗效。方法回顾性分析2015年2月至2020年2月郑州大学第一附属医院神经介入科收治的采用PED治疗的颅内动脉瘤患者103例(108个动脉瘤)。其中颈内动脉颅内段小型动脉瘤65例,Willis环远端动脉瘤23例,椎-基底动脉动脉瘤15例;囊状动脉瘤83例,夹层和梭形动脉瘤20例;破裂动脉瘤9例,未破裂动脉瘤94例。术后采用O′Kelly Marotta(OKM)分级标准判断动脉瘤的闭塞程度,采用改良Rankin量表评分(mRS)评估临床预后。结果103例患者(108个动脉瘤)共置入109枚支架,支架置入成功率为100%。术后即刻动脉瘤闭塞OKM分级A级45例(43.7%)、B级42例(40.8%)、C级6例(5.8%)、D级10例(9.7%)。103例患者中,围手术期9例(8.7%)发生并发症,其中出血性事件1例(1.0%),缺血性事件8例(7.8%),死亡1例(1.0%)。术后12个月,102例患者中,mRS评分≤2分者99例(97.1%),3~5分3例(2.9%);79例行数字减影血管造影检查,其中OKM分级B级和C级各7例(各占8.9%),D级65例(82.2%),无一例患者的动脉瘤复发。结论采用PED治疗颈内动脉颅内段小型动脉瘤、椎-基底动脉动脉瘤及Willis环远端动脉瘤,围手术期并发症少,手术效果好。

Safety and efficacy of Pipeline embolization device in the treatment of intracranial aneurysms

Objective To summarize the safety and efficacy of the Pipeline embolization device in the treatment of intracranial aneurysms.Methods A retrospective analysis was conducted on 103 patients with 108 intracranial aneurysms who were admitted to the Department of Neurointervention,the First Affiliated Hospital of Zhengzhou University and treated with PED from February 2015 to February 2020.Among them,65 cases were small intracranial aneurysms in the internal carotid artery,23 cases were distal aneurysms of the circle of Willis and 15 cases were vertebra-basilar aneurysms;83 cases were saccular aneurysms and 20 cases were dissecting and fusiform aneurysms;9 cases were ruptured aneurysms and 94 cases were unruptured aneurysms.After operation,the O′Kelly Marotta(OKM)grading standard was used to judge the degree of occlusion of aneurysm,and the modified Rankin scale(mRS)was used to evaluate the clinical prognosis.Results A total of 109 stents were placed in 103 patients(108 aneurysms),and the success rate of stent placement was 100%.The immediate postoperative aneurysm occlusion results indicated grade A in 45 cases(43.7%),grade B in 42 cases(40.8%),grade C in 6 cases(5.8%)and grade D in 10 cases(9.7%)based on the OKM classification.Among 103 patients,9(8.7%)had complications during the perioperative period,including 1 hemorrhagic event(1.0%),8 ischemic events(7.8%)and 1 death(1.0%).At 12 months postoperatively,99 patients(97.1%)had mRS scores≤2 points among 102 patients,and 3 patients(2.9%)scored between 3 and 5 points.A total of 79 patients underwent digital subtraction angiography(DSA)examination,which indicated grade B in 7 cases(8.9%)and grade C in 7 cases(8.9%),grade D in 65 cases(82.2%),and none of the patients had aneurysm recurrence.Conclusion For the treatment of small intracranial aneurysms of the internal carotid artery,vertebra-basilar and distal aneurysms of the circle of Willis,PED is associated with fewer perioperative complications and favorable surgical outcomes.