血流导向装置治疗颅内大型和巨大型动脉瘤的效果分析

发布时间：2018-08-25 10:28

【摘要】：目的探讨Pipeline血流导向装置(PED)治疗颅内大型、巨大型动脉瘤的安全性及有效性。方法回顾性连续纳入2014年11月至2016年5月第二军医大学附属长海医院神经外科经DSA或头部CT血管成像(CTA)或头部MR血管成像(MRA)证实为颅内动脉瘤的患者33例,并对其临床及影像学资料进行分析,评价其安全性及有效性。结果 33例患者共35个动脉瘤,均成功释放PED,其中10个动脉瘤采用单纯PED置入,25个采用PED置入结合弹簧圈栓塞术(包含2个采用Pipeline桥接技术)。围手术期出现1例(1个动脉瘤)血栓栓塞事件并出血转化,1例(1个动脉瘤)因致死性动脉瘤延迟出血而死亡。临床随访31例(33个动脉瘤),随访时间为术后4~18个月,无出血或血栓栓塞事件发生。18个动脉瘤获术后短期影像学随访(3~5个月,增强MRA或DSA),其中10个瘤颈残留或瘤体显影,8个动脉瘤完全不显影;19个动脉瘤获术后中期影像学随访(6~16个月,增强MRA或DSA),其中2个瘤颈残留,17个动脉瘤完全不显影。结论 PED治疗颅内大型和巨大型动脉瘤安全有效,但血流导向装置置入后颅内出血的并发症不可忽视,其相关机制需进一步研究。
[Abstract]:Objective to evaluate the safety and efficacy of Pipeline (PED) in the treatment of large and large intracranial aneurysms. Methods from November 2014 to May 2016, 33 patients with intracranial aneurysms confirmed by DSA or head CT angiography (CTA) or head MR angiography (MRA) were retrospectively included in the neurosurgery department of Changhai Hospital affiliated to the second military Medical University from November 2014 to May 2016. The clinical and imaging data were analyzed to evaluate its safety and effectiveness. Results 35 aneurysms were successfully released from 33 patients, of which 10 aneurysms were implanted by PED alone and 25 by PED implantation combined with coils embolization (including 2 with Pipeline bridging technique). One case (1 aneurysm) had thromboembolism and 1 case (1 aneurysm) died of delayed bleeding due to fatal aneurysm during perioperative period. Thirty-one patients (33 aneurysms) were followed up for 4 ~ 18 months without bleeding or thromboembolism. MRA or DSA), showed 10 residual aneurysms or tumors, 8 aneurysms were not developed at all, 19 aneurysms were followed up for 6 ~ 16 months (6 ~ 16 months), 2 aneurysms remained in enhanced MRA or DSA), and 17 aneurysms were not seen at all. Conclusion PED is safe and effective in the treatment of large and large intracranial aneurysms, but the complications of intracranial hemorrhage after placement of blood flow guidance device should not be ignored, and the related mechanism needs further study.
【作者单位】：第二军医大学附属长海医院神经外科;
【基金】：上海市科委重大课题(13411950300);上海市科委产学研合作项目(14441904702)
【分类号】：R651.12

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