Pipeline血流导向装置在治疗颈内动脉大型或巨大型宽颈动脉瘤中的初步应用

Preliminary application of pipeline embolization device in the treatment of large or giant wide-necked aneurysms of the internal carotid artery

摘要:

目的：初步探讨Pipeline血流导向装置（pipeline embolization device，PED）治疗颈内动脉大型或巨大型宽颈动脉瘤的临床效果。方法：回顾性分析我院神经外科2016年4月至2018年4月应用PED治疗的14例颈内动脉大型或巨大型宽颈动脉瘤的临床资料，采用Kamran分级、改良Rankin量表（modified Rankin scale，mRS）评分及影像学方法评估临床疗效。结果：14例患者共15个动脉瘤，均为颈内动脉大型或巨大型宽颈未破动脉瘤，单纯PED置入2例，联合弹簧圈栓塞12例，其中13例PED顺利到位释放，1例失败，PED疝入瘤腔。PED成功置入术中即刻造影显示瘤腔内对比剂明显滞留。术后并发症2例（14%），1例颅神经麻痹症状加重，1例为血栓性事件。出院时mRS评分0分12例，1分2例，术后6个月14例患者均行数字减影血管造影（digital subtraction angiography，DSA）检查，13例动脉瘤完全或近完全闭塞，1例PED疝入瘤腔的患者载瘤动脉闭塞，患者仅遗留眼睑下垂，临床随访6～21个月，余13例均未出现神经功能缺损症状。结论：PED置入治疗颈内动脉大型或巨大型宽颈动脉瘤短期评估疗效好，且安全，联合弹簧圈治疗可提高闭塞率，有可能减少术后动脉瘤破裂出血风险，但其远期疗效仍需进一步评价。

Abstract:

Objective：To preliminarily explore the clinical effect of pipeline embolization device in the treatment of large or giant wide-necked aneurysms of the internal carotid artery. Methods：A retrospective analysis was performed on the clinical data of 14 pa－tients with large or giant wide-necked aneurysms of the internal carotid artery who were treated with PED from April 2016 to April 2018 in the neurosurgery department of our hospital. And the clinical efficacy was evaluated by Kamran grading，modified Rankin Scale（mRS），and radiological examination. Results：There were 15 aneurysms in 14 patients，all of which were large or giant wide-necked unruptured aneurysms of the internal carotid artery，Two cases were implanted with PED alone，while in the other 12 cases PED was given concurrently with coil embolization. Among these cases，PED was successfully released in 13 cases but failed in 1 case whose PED herniated into the lumen of the aneurysm. Immediately after the successful placement of PED，the contrast agent showed obvious retention in the lumen of the aneurysm. Postoperative complications occurred in 2 cases（14%），cranial nerve palsy worsened in 1 case，and thrombotic events happened in 1 case. At discharge，mRS score was 0 in 12 cases and 1 in 2 cases. At 6 months after surgery，14 patients underwent digital subtraction angiography. Thirteen patients had complete or nearly complete occlusion of aneurysm，and one with PED hernia into the lumen of the aneurysm had occlusion of the artery with aneurysm，and only blepharoptosis was left in this patient. During follow-up at 6 to 21 months，no symptoms of neurological defects were found in the remaining 13 patients. Conclusion：PED in the treatment of large or giant wide-necked aneurysms of the internal carotid artery has good therapeutic efficacy and safety in short-term evaluation. PED combined with coil embolization can improve the occlusion rate and may reduce the risk of postoperative aneurysm rupture and bleeding，but its long-term efficacy still needs further evaluation.