血管内治疗颅内动脉瘤的影像学及临床预后分析

目的 探讨颅内动脉瘤的临床特征及血管内治疗的安全性和有效性。方法 回顾性分析2011年1月至2016年12月首都医科大学附属北京朝阳医院神经外科行血管内治疗的91例颅内动脉瘤患者。评价指标包括：影像学结果、临床预后和手术合并症。Cox比例风险回归模型分析影响动脉瘤复发和临床预后的危险因素。结果 本组患者中男性36例，女性55例，平均年龄（45.9±11.1）岁。破裂动脉瘤58例，Hunt-Hess Ⅲ~Ⅴ级9例。单纯弹簧圈栓塞48例，球囊辅助栓塞28例，支架辅助栓塞15例。颅内动脉瘤复发12例（13.2%）。Cox回归分析显示，动脉瘤破裂史、大动脉瘤及宽颈动脉瘤是影响复发的危险因素。良好临床预后80例（87.9%），高Hunt-Hess评分是预测不良预后的独立危险因素。12例患者出现手术相关合并症。结论 血管内治疗颅内动脉瘤临床预后良好；动脉瘤大小、瘤颈和破裂史是预测动脉瘤复发的危险因素；入院时高Hunt-Hess评分的动脉瘤患者病死率及残疾率高。

Endovascular treatment of intracranial aneurysms: angiographic features and treatment outcome

Objective To evaluate safety and efficacy profiles of intracranial aneurysms treated with endovascular techniques. Methods We searched our characteristics of intracranial aneurysms prospectively maintained database of Beijing Chaoyang Hospital, Capital Medical University and identified 91 patients treated with endovascular treatment between the years 2011 and 2016. The patients' angiographic outcomes, clinical outcomes and perioperative complications were reviewed retrospectively. Cox regression analysis were applied to determine the risk factors for aneurysms recurrence and the predictors for clinical outcomes. Results We studied these patients who included 55 females and 36 males with a mean age of (45.9±11.1) years. There were 58 ruptured intracranial aneurysms. Of them, Hunt-Hess Ⅲ-Ⅴ in 9 patients. In 48 aneurysms, the treatment was attempted with coiling alone. Stent-assisted technique (SAT) was in 15 patients and balloon remodeling technique (BRT) in 18 patients. In the follow-up angiography, recurrences rate was observed in 13.2% of the cases. According to Cox regression analysis, size of aneurysm, neck size and ruptured status were independently associated with increased risk of aneurysm recurrence. Good functional outcome was achieved in 87.9%. High Hunt-Hess grade at admission was independent predictors of poor functional outcome in the multivariate analysis. However, 12 patients had procedure-related complications. Conclusion The endovascular treatment of intracranial aneurysms is feasible and has a good clinical outcome. Size of aneurysm, neck size and ruptured status were independently associated with increased risk of aneurysm recurrence. However, patient with high Hunt-Hess grade aneurysms, morbidity and mortality rates remain high.