支架辅助弹簧圈栓塞治疗血泡样动脉瘤的临床疗效分析

doi:10.3877/cma.j.issn.2095-123X.2021.05.002

目的

研究血泡样动脉瘤（BBA）支架辅助弹簧圈栓塞治疗的可行性和有效性。

方法

回顾性分析南京大学医学院附属鼓楼医院神经外科自2014年8月至2018年12月行支架辅助弹簧圈栓塞治疗的18例BBA患者的临床资料，统计其临床特点，总结诊疗经过和随访结果。

结果

18例患者中单支架辅助4例，双支架辅助8例，三支架辅助5例，四支架辅助1例，平均支架使用数2.2枚。14例患者正常出院，均接受电话随访，改良Rankin量表评分均为0~2级，其中11例患者接受脑DSA随访，随访时间范围7~664 d，动脉瘤完全栓塞无复发。4例死亡患者中2例为动脉瘤再出血。术前Hunt-Hess Ⅰ~Ⅲ级患者具有良好预后的比例为92.3%（12/13），Hunt-Hess Ⅳ级的患者具有良好预后的比例为40%（2/5），总体预后良好率为77.8%（14/18）。

结论

支架辅助弹簧圈栓塞是治疗颅内BBA的有效手段，同时术前的Hunt-Hess低分级的患者预后显著优于高分级患者。

关键词: 血泡样动脉瘤, 血管内治疗, 支架辅助弹簧圈栓塞

Objective

To investigate the feasibility and effectiveness of stent-assisted coil embolization for blood blister-like aneurysm (BBA).

Methods

From August 2014 to December 2018, 18 BBA patients were treated with stent-assisted coil embolization in Neurosurgery Department of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, a retrospective analysis was made of the general data, clinical features and follow-up results.

Results

Among the 18 patients, 4 were assisted by single stent, 8 by double stents, 5 by three stents and 1 by four stents. The average number of stents used was 2.2. Fourteen patients were discharged normally and all received telephone follow-up, the scores of the modified Rankin scale were 0-2. Among them, 11 patients were followed up by cerebral angiography, The follow-up time ranged from 7 to 664 d, the aneurysms were completely embolized without recurrence. Among the 4 dead patients, 2 were aneurysmal rebleeding. The proportion of patients with Hunt-Hess grade Ⅰ-Ⅲ had a good prognosis was 92.3% (12/13), the proportion of patients with Hunt-Hess grade Ⅳ had a good prognosis was 40% (2/5), and the overall good prognosis rate was 77.8% (14/18). The good prognosis of this group of patients was 77.8% (14/18).

Conclusion

Stent assisted coil embolization is an effective treatment for intracranial BBA, at the same time, the prognosis of patients with low Hunt-Hess grade was significantly better than that of patients with high grade.

Key words: Blood blister-like aneurysms, Endovascular treatment, Stent-assisted coil embolization

表1 18例血泡样动脉瘤患者的一般资料、治疗及随访资料

序号	性别	年龄（岁）	侧别	位置	Hunt-Hess分级	支架数量	mRs评分	影像随访
序号	性别	年龄（岁）	侧别	位置	Hunt-Hess分级	支架数量	mRs评分	术后时间（d）	随访结果
1	女	68	左	C6	Ⅱ	1	0	151	不显影
2	女	57	右	C6	Ⅰ	1	2	664	不显影
3	男	47	右	C6	Ⅱ	1	0	203	不显影
4	女	47	右	C7	Ⅱ	1	0	459	不显影
5	男	29	右	C6	Ⅳ	2	0	172	不显影
6	男	55	右	C6	Ⅳ	2	-	-	-
7	女	61	左	C7	Ⅱ	2	0	-	-
8	女	46	右	C6	Ⅲ	3	0	133	不显影
9	男	57	右	C6	Ⅳ	3	-	-	-
10	男	42	左	C6	Ⅰ	3	0	355	不显影
11	女	34	右	C7	Ⅳ	2	0	-	-
12	女	49	右	C6	Ⅳ	3	-	-	-
13	女	33	左	C6	Ⅱ	2	0	94	不显影
14	女	48	右	C6	Ⅱ	2	0	-	-
15	女	46	右	C6	Ⅱ	3	0	9	不显影
16	女	50	右	C6	Ⅲ	2	-	-	-
17	男	56	右	C6	Ⅱ	2	0	7	不显影
18	女	55	右	C6	Ⅲ	4	0	67	不显影

表1 18例血泡样动脉瘤患者的一般资料、治疗及随访资料

序号	性别	年龄（岁）	侧别	位置	Hunt-Hess分级	支架数量	mRs评分	影像随访
序号	性别	年龄（岁）	侧别	位置	Hunt-Hess分级	支架数量	mRs评分	术后时间（d）	随访结果
1	女	68	左	C6	Ⅱ	1	0	151	不显影
2	女	57	右	C6	Ⅰ	1	2	664	不显影
3	男	47	右	C6	Ⅱ	1	0	203	不显影
4	女	47	右	C7	Ⅱ	1	0	459	不显影
5	男	29	右	C6	Ⅳ	2	0	172	不显影
6	男	55	右	C6	Ⅳ	2	-	-	-
7	女	61	左	C7	Ⅱ	2	0	-	-
8	女	46	右	C6	Ⅲ	3	0	133	不显影
9	男	57	右	C6	Ⅳ	3	-	-	-
10	男	42	左	C6	Ⅰ	3	0	355	不显影
11	女	34	右	C7	Ⅳ	2	0	-	-
12	女	49	右	C6	Ⅳ	3	-	-	-
13	女	33	左	C6	Ⅱ	2	0	94	不显影
14	女	48	右	C6	Ⅱ	2	0	-	-
15	女	46	右	C6	Ⅱ	3	0	9	不显影
16	女	50	右	C6	Ⅲ	2	-	-	-
17	男	56	右	C6	Ⅱ	2	0	7	不显影
18	女	55	右	C6	Ⅲ	4	0	67	不显影

图1 典型病例治疗前后影像学资料A：治疗前颈内动脉前壁可见一不规则突起；B：单纯三枚支架置入后动脉瘤形态发生变化，但动脉瘤仍然显影；C：治疗1周后见动脉瘤形态发生变化，体积增大；D：治疗2周后动脉瘤体积进一步增大；E：再次行支架辅助弹簧圈栓塞术后即刻造影动脉瘤完全闭塞；F：3个月后复查动脉瘤无复发

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Clinical efficacy analysis of stent assisted coil embolization in the treatment of intracranial blood blister-like aneurysm

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Clinical efficacy analysis of stent assisted coil embolization in the treatment of intracranial blood blister-like aneurysm