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]	李霞, 周鸿. 肺癌乳腺转移合并肺栓塞1例[J]. 中华乳腺病杂志(电子版), 2024, 18(03): 189-191.
[2]	王晓亚, 王燕芸, 顾永忠. 产科快速反应团队成功救治心脏骤停孕产妇1例并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 148-156.
[3]	麦子结, 曾学晴, 张乾升, 刘永达. 输尿管软镜术后严重出血治疗的初步探索[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 366-371.
[4]	潘兴赫, 董翔, 杨海洋, 张雪斌, 甘卫东. 超选择性前列腺动脉栓塞治疗伴急性尿潴留的高危高龄前列腺增生[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 237-242.
[5]	赵信燕, 岳晓霞, 曹瑞玲, 张惠丽, 李向杰. 急性肺栓塞影像学及临床特征分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 296-299.
[6]	陈杨, 李茜, 杨中华. 慢性阻塞性肺疾病急性加重期合并VTE抗凝治疗的研究进展[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 316-319.
[7]	宋燕京, 乔江春, 宋京海. 中晚期肝癌TACE联合免疫靶向转化治疗后右半肝切除术一例[J]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 227-230.
[8]	张艺, 任秀君, 郭孟玮, 赵雅芳, 李一凡, 李佳阳, 任晓暄, 邬继红, 卢海洋. 电针预处理对脑缺血再灌注大鼠行为学及外周血内皮祖细胞的影响[J]. 中华神经创伤外科电子杂志, 2024, 10(02): 71-77.
[9]	鲍乐, 刘颖, 王友彬, 陈龙, 朱玉芝, 梁爽, 权鹤太, 李鹏飞. 还阳通络灸在原发性肝癌介入治疗中的临床应用研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(03): 197-202.
[10]	徐啸阳, 张帅, 仲斌演, 沈健, 朱晓黎. 血管腔内介入治疗肾动脉瘤的临床疗效分析[J]. 中华介入放射学电子杂志, 2024, 12(02): 137-143.
[11]	郭亚潘, 孙敬, 孙鹏程, 张鑫, 朱碧云, 李智, 倪才方. 超选择栓塞治疗急性肾出血及CT血管成像在显示责任血管中的作用[J]. 中华介入放射学电子杂志, 2024, 12(02): 155-160.
[12]	吕丽爱, 赖林强, 张登科. 载药微球子宫动脉化疗栓塞治疗局部晚期宫颈癌病理完全缓解患者一例[J]. 中华介入放射学电子杂志, 2024, 12(02): 190-192.
[13]	刘一人, 崔世军, 佟铸, 郭建明, 杨盛家, 谷涌泉, 郭连瑞. 急性肠系膜上动脉栓塞的介入治疗[J]. 中华介入放射学电子杂志, 2024, 12(02): 131-136.
[14]	宋勇战, 刘宝龙, 王萍, 周登明, 刘永胜. 卵圆孔未闭封堵治疗单中心经验[J]. 中华心脏与心律电子杂志, 2024, 12(02): 94-101.
[15]	许英, 彭采凤, 曾梁楠, 李倩茜, 杨昌美. 未破裂颅内动脉瘤介入治疗患者自我管理干预方案的构建[J]. 中华脑血管病杂志(电子版), 2024, 18(02): 164-170.

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