支架辅助血管分叉部位颅内动脉瘤栓塞对血管形态改变的研究

发布时间：2018-09-18 10:37

【摘要】：研究背景与目的：颅内动脉瘤是神经外科常见的脑血管疾病,动脉瘤破裂引起蛛网膜下腔出血致残致死率高,死亡率可高达25-60%。随着技术的进步,采用记忆合金制作血管内微支架逐渐应用于颅内动脉瘤的治疗,尤其是在颅内宽颈动脉瘤的栓塞过程中,采用支架辅助栓塞能起到满意的栓塞效果。血管内支架的植入,可以对弹簧圈起到很好的支撑作用,在填塞宽颈动脉瘤过程中,可以有效的防止弹簧圈脱出,起到稳定弹簧圈的作用,使弹簧圈在瘤内达到致密填塞。与此同时,由于血管内栓塞材料的植入,局部血管的相关参数将会受到一定的影响。然而,目前临床上缺少能证实支架治疗动脉瘤安全性和疗效的大宗病例报道,支架在颅内的应用还有一些安全性问题需要研究评估。本次研究是通过对支架辅助栓塞血管分叉部位颅内动脉瘤短期和长期的随访,研究血管内支架的植入对局部血管的几何构型及分叉部位血管角度改变。临床中发现血管内支架的植入会明显的改变植入部位血管的形状,因此希望通过本研究,探究支架引起的血管变形与血管分叉部位动脉瘤患者预后之间的相关性。研究方法：回顾分析2011年～2014年在我院接受介入治疗的颅内宽颈动脉瘤患者资料,选取接受血管内支架辅助栓塞治疗的30例颅内动脉分叉部位动脉瘤患者,应用了31枚自膨式支架,辅助栓塞31个动脉分叉部动脉瘤,应用13枚Solitaire支架和18枚Enterprise支架。采用三维脑血管造影图像处理技术,测量血管分叉部位主干血管与分支血管之间的夹角,采用统计学分析术前与术后及术后随访的脑血管造影结果,观察血管几何构型的改变,及与动脉瘤复发之间相关性。研究结果：血管内支架的植入明显改变了血管分叉部位的角度,且远端血管的变化较近端血管的变化更明显(AcoAMCABAICA-PcoA)。随着随访时间的延长,血管的角度改变越明显。在血管分叉部位动脉瘤的栓塞治疗过程中,支架辅助栓塞可以降低动脉瘤的复发率。研究结论：血管内支架的植入可以改变动脉分叉部位血管的形态,引起主干血管与分支血管之间的夹角改变,这种改变与血管分叉的位置及应用的支架类型有关。另外,血管内支架的应用可以有效的降低动脉瘤的复发率,在治疗颅内动脉分叉部位动脉瘤方面安全可靠。
[Abstract]:Background & objective: intracranial aneurysm is a common cerebrovascular disease in neurosurgery. With the development of technology, the use of memory alloy to make intravascular microstent gradually used in the treatment of intracranial aneurysms, especially in the embolization process of intracranial wide-necked aneurysms, stent-assisted embolization can play a satisfactory embolization effect. The implantation of intravascular stent can support the coil very well. In the process of packing wide neck aneurysm, it can effectively prevent the coils from coming out and stabilize the coils, so that the coils can be tightly packed in the tumor. At the same time, the parameters of local vessels will be affected due to the implantation of endovascular embolization materials. However, there is a lack of clinical evidence of the safety and efficacy of stenting for aneurysms, and there are still a number of safety issues to be studied and evaluated for the use of stents in intracranial aneurysms. The purpose of this study was to investigate the effects of stent-assisted embolization of intracranial aneurysms on local vascular geometry and the angle of the branched vessels. It is hoped that the relationship between angioplasty induced by stents and the prognosis of patients with aneurysms at the bifurcation site will be explored through this study. Methods: the data of patients with intracranial wide-necked aneurysms received interventional therapy in our hospital from 2011 to 2014 were retrospectively analyzed. Thirty patients with intracranial artery bifurcation aneurysms received endovascular stent-assisted embolization. 31 self-expandable stents were used to embolize 31 artery bifurcation aneurysms, 13 Solitaire stents and 18 Enterprise stents were used. Three-dimensional angiography image processing technique was used to measure the angle between the main vessel and the branch vessel in the bifurcation part of the blood vessel. The results of cerebral angiography before and after operation were statistically analyzed to observe the changes of the geometric configuration of the blood vessel. And its association with aneurysm recurrence. Results: the angle of vascular bifurcation was significantly changed by the implantation of endovascular stent, and the change of distal vessel was more obvious than that of proximal vessel (AcoAMCABAICA-PcoA). With the extension of follow-up time, the change of the angle of blood vessel became more obvious. Stent-assisted embolization can reduce the recurrence rate of aneurysms. Conclusion: endovascular stent implantation can change the shape of the artery and cause the change of the angle between the main vessel and the branch vessel, which is related to the position of the vascular bifurcation and the type of stent used. In addition, the application of endovascular stent can effectively reduce the recurrence rate of aneurysms and is safe and reliable in the treatment of intracranial artery bifurcation aneurysms.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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