血流导向装置治疗血泡样动脉瘤的临床效果分析

doi:10.3877/cma.j.issn.2095-123X.2024.03.007

目的

探讨血流导向装置（FD）治疗血泡样动脉瘤（BBA）的安全性及有效性。

方法

收集南昌大学第一附属医院神经外科自2015年1月至2022年12月行FD治疗的BBA患者的临床资料，分析其临床特征、手术结果及预后。

结果

共纳入5例患者，FD置入操作成功率100.0%，围术期无缺血及出血情况发生。平均随访（4.40±1.51）个月，其中动脉瘤治愈4例，复发1例；复发患者在出院后4个月出现右侧额颞脑梗死。出院时所有患者mRS评分0分，末次随访mRS评分0分4例，4分1例。

结论

FD治疗BBA具有一定的安全性和有效性。

关键词: 血泡样动脉瘤, 血流导向装置, 血管内治疗, 栓塞

Objective

To explore the clinical safety and efficacy of flow diverter (FD) to treat blood blister-like aneurysms (BBA).

Methods

The clinical dates of BBA patients who underwent FD treatment in the Neurosurgery Department of the First Affiliated Hospital of Nanchang University from January 2015 to December 2022 were collected, their clinical characteristics, surgical results and prognosis were further analyzed.

Results

Five cases with BBA treated by FD were enrolled finally. All of operative procedures were success in this study, and there were no complications and rebleeding in perioperative period. The average follow-up period was (4.40±1.51) months, with 4 cases of aneurysm cured and 1 case of recurrence who had suffered brain infraction located in right frontotemporal area after four months follow-up. The mRS score was 0 when all patients were discharge, but at the last follow-up, 4 cases with mRS were 0, one with mRS was 4.

Conclusion

The FD treatment for BBA has certain safety and effectiveness.

Key words: Blood blister-like aneurysm, Flow diverter, Endovascular therapy, Embolization

表1 5例血泡样动脉瘤患者的临床资料

Tab.1 Clinical data of 5 patients with BBA

序号	年龄（岁）	性别	动脉瘤位置	Hunt-Hess分级（级）	Fisher分级（级）	支架类型	Raymond分级（级）	出院后随访时间（月）	影像学结果	末次随访mRS评分（分）
1	59	女	L-ICA C6	Ⅰ	Ⅰ	Tubridge	Ⅰ	3	治愈	0
2	49	女	R-ICA C6	Ⅱ	Ⅳ	Pipeline	Ⅱ	4	复发	4
3	36	女	L-ICA C6	Ⅲ	Ⅲ	Tubridge	Ⅰ	6	治愈	0
4	38	男	R-ICA C6	Ⅰ	Ⅰ	Tubridge	Ⅰ	6	治愈	0
5	46	女	R-ICA C6	Ⅱ	Ⅰ	Pipeline	Ⅰ	3	治愈	0

表1 5例血泡样动脉瘤患者的临床资料

Tab.1 Clinical data of 5 patients with BBA

序号	年龄（岁）	性别	动脉瘤位置	Hunt-Hess分级（级）	Fisher分级（级）	支架类型	Raymond分级（级）	出院后随访时间（月）	影像学结果	末次随访mRS评分（分）
1	59	女	L-ICA C6	Ⅰ	Ⅰ	Tubridge	Ⅰ	3	治愈	0
2	49	女	R-ICA C6	Ⅱ	Ⅳ	Pipeline	Ⅱ	4	复发	4
3	36	女	L-ICA C6	Ⅲ	Ⅲ	Tubridge	Ⅰ	6	治愈	0
4	38	男	R-ICA C6	Ⅰ	Ⅰ	Tubridge	Ⅰ	6	治愈	0
5	46	女	R-ICA C6	Ⅱ	Ⅰ	Pipeline	Ⅰ	3	治愈	0

图1 左侧颈内动脉BBA血流导向装置治疗的影像学资料A：术前CT示蛛网膜下腔出血；B：术前CTA示左侧颈内动脉末端前壁动脉瘤（箭头所示）；C：急诊术中DSA不同角度脑血管三维示左侧颈内动脉C6段前壁BBA（箭头所示）；D：术中DSA示Tubridge支架（4.5 mm×20 mm）联合弹簧圈致密栓塞BBA（箭头所示）；E：出院时复查DSA示动脉瘤治愈（箭头所示）；F：出院后6个月DSA复查示BBA未见复发（箭头所示）；BBA：血泡样动脉瘤

Fig.1 Imaging data for ruptured BBA treated by flow diverter in the left internal carotid artery

图2 右侧颈内动脉BBA血流导向装置治疗的影像学资料A：术前颅脑CT示蛛网膜下腔出血；B：术前CTA示右侧颈内动脉末端前壁BBA（箭头所示）；C：术中DSA示Pipeline支架（4.25 mm×20.0 mm）联合弹簧圈致密栓塞动脉瘤（箭头所示）；D：出院后3个月DSA复查示动脉瘤治愈（箭头所示）；BBA：血泡样动脉瘤

Fig.2 Imaging data for ruptured BBA treated by flow diverter in the right internal carotid artery

[1]	Çinar C, Oran İ, Bozkaya H, et al. Endovascular treatment of ruptured blister-like aneurysms with special reference to the flow-diverting strategy[J]. Neuroradiology, 2013, 55(4): 441-447. DOI: 10.1007/s00234-013-1136-y.
[2]	Peitz GW, Sy CA, Grandhi R. Endovascular treatment of blister aneurysms[J]. Neurosurg Focus, 2017, 42(6): E12. DOI: 10.3171/2017.3.FOCUS1751.
[3]	Luo C, Jin L, Dong J, et al. Clinical outcomes of pipeline embolization devices with shield technology for treating intracranial aneurysms[J]. Front Neurol, 2022, 13: 971664. DOI: 10.3389/fneur.2022.971664.
[4]	闫亚洲,诸德源,赵普远,等.血流导向装置在血泡样动脉瘤治疗中安全性和有效性的Meta分析[J].中国临床神经外科杂志, 2018, 23(10): 670-672, 697. DOI: 10.13798/j.issn.1009-153X.2018.10.009.
[5]	Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms[J]. J Neurosurg, 1968, 28(1): 14-20. DOI: 10.3171/jns.1968.28.1.0014.
[6]	Quinn TJ, Dawson J, Walters MR, et al. Variability in modified Rankin scoring across a large cohort of international observers[J]. Stroke, 2008, 39(11): 2975-2979. DOI: 10.1161/strokeaha.108.515262.
[7]	Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms[J]. Stroke, 2001, 32(9): 1998-2004. DOI: 10.1161/hs0901.095600.
[8]	Phillips TJ, Wenderoth JD, Phatouros CC, et al. Safety of the pipeline embolization device in treatment of posterior circulation aneurysms[J]. AJNR Am J Neuroradiol, 2012, 33(7): 1225-1231. DOI: 10.3174/ajnr.A3166.
[9]	吴一娜,路智文,段国礼,等. Tubridge血流导向装置治疗支架辅助栓塞后复发性颈内动脉血泡样动脉瘤[J].国际脑血管病杂志, 2021, 29(10): 750-754. DOI: 10.3760/cma.j.issn.1673-4165.2021.10.006.
[10]	Senol YC, Sayin B, Oz ZG, et al. Treatment of ruptured anterior choroidal artery aneurysms by acute coiling followed by flow diversion[J]. World Neurosurg, 2023, 176: e162-e172. DOI: 10.1016/j.wneu.2023.05.023.
[11]	Ogawa A, Suzuki M, Ogasawara K. Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms[J]. Neurosurgery, 2000, 47(3): 578-586. DOI: 10.1097/00006123-200009000-00008.
[12]	Ricciardi L, Trungu S, Scerrati A, et al. Surgical treatment of intracranial blister aneurysms: a systematic review[J]. Clin Neurol Neurosurg, 2021, 202: 106550. DOI: 10.1016/j.clineuro.2021.106550.
[13]	Peschillo S, Cannizzaro D, Caporlingua A, et al. A systematic review and meta-analysis of treatment and outcome of blister-like aneurysms[J]. AJNR Am J Neuroradiol, 2016, 37(5): 856-861. DOI: 10.3174/ajnr.A4606.
[14]	徐建军,王宏磊,乔萌,等.血管内介入治疗合并单侧烟雾病的前交通动脉瘤[J].中华神经创伤外科电子杂志, 2022, 8(1): 39-43. DOI: 10.3877/cma.j.issn.2095-9141.2022.01.008.
[15]	Wang C, Tian Z, Liu J, et al. Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with enterprise stents and the pipeline device[J]. J Transl Med, 2016, 14(1): 199. DOI: 10.1186/s12967-016-0959-9.
[16]	Meckel S, Singh TP, Undrén P, et al. Endovascular treatment using predominantly stent-assisted coil embolization and antiplatelet and anticoagulation management of ruptured blood blister-like aneurysms[J]. AJNR Am J Neuroradiol, 2011, 32(4): 764-771. DOI: 10.3174/ajnr.A2392.
[17]	Lim YC, Song J. Long-term outcomes of ruptured blood blister-like aneurysms with multiple (≥2) overlapping stents and coiling: a single-center experience[J]. World Neurosurg, 2023, 175: e950-e958. DOI: 10.1016/j.wneu.2023.04.047.
[18]	魏鹏,唐景峰,郑华平.血泡样动脉瘤血管内介入治疗新进展[J].中外医疗, 2019, 38(9): 195-198. DOI: 10.16662/j.cnki.1674-0742.2019.09.195.

[1]	吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[2]	姚金含, 王伟娜, 张玉泉. 妊娠相关深静脉血栓形成患者的预后研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 367-373.
[3]	汤宏涛, 何坤. 中晚期肝细胞癌介入治疗的进展及前景[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 305-308.
[4]	李国煜, 丛赟, 祖丽胡马尔·麦麦提艾力, 何铁英. 急性胰腺炎并发门静脉系统血栓形成的危险因素及预测模型构建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 266-270.
[5]	常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6]	张春玉, 陈海云, 肖忠萍, 罗琴, 潘运昌. 血清NT-proBNP 预测肺栓塞心脏功能障碍的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 805-808.
[7]	公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[8]	李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[9]	刘华亭, 张媛, 张登文, 王杰, 袁阳. 介入栓塞联合手术切除治疗头皮动静脉畸形的疗效观察[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 273-278.
[10]	蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
[11]	于洁, 金小红, 顾艳楣, 王慧, 葛杨杨, 李燕. 癌症相关静脉血栓栓塞症患者疾病体验与需求的质性研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 739-744.
[12]	赖海洋, 吴可通, 刘洋, 李丹, 彭焘, 万源, 张波. 术前经动脉栓塞在椎体转移瘤切除术中的应用[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 327-332.
[13]	朱洪申, 王思权, 彭靓, 张晓斌, 郑美云, 陈锦华. Glubran-2栓塞治疗鼻咽癌相关难治性鼻出血的临床疗效[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 333-337.
[14]	崔伟, 李静, 陈晓明, 张靖, 邓屹, 许荣德. 载药微球支气管动脉化疗栓塞术治疗非小细胞肺癌的研究进展[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 289-295.
[15]	程娅雯, 韩香凝, 朱宁, 何彩莲, 张润宁, 于嘉, 韩建峰, 刘福德. 双路途指导下血管内治疗症状性非急性颈内动脉颅内段闭塞的疗效观察[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 330-337.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Clinical outcomes of blood blister-like aneurysm treated by flow diverter

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Clinical outcomes of blood blister-like aneurysm treated by flow diverter