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目的 探讨置入Pipeline血流导向装置(PED)治疗老年颅内动脉瘤患者的安全性及临床疗效。方法 回顾性分析2018年10月至2022年10月解放军总医院第一医学中心神经内科介入病区的使用PED治疗的老年颅内动脉瘤患者30例(共39个动脉瘤),使用O'Kelly-Marotta(OKM)分级标准评估颅内动脉瘤的闭塞程度，使用改良的Rankin量表(mRS)评分判断老年患者出院时及随访时的临床预后。结果 30例老年患者共置入34枚支架，置入成功率为100%。动脉瘤术后即刻OKM分级A、B、C、D级分别为29个(74.4%)、10个(25.6%)、0个、0个，出院时良好预后率(mRS评分0～2分)为96.7%。14例患者共21个动脉瘤获全脑数字减影血管造影术随访，动脉瘤缩小(OKM好转)19个(90.5%);闭塞(OKM C级+D级)12个(57.1%),随访中未发现动脉瘤复发、支架内再狭窄、神经系统症状。30例患者获电话随访，随访时间中位数为9个月，良好预后率为100%。结论 应用Pipeline血流导向装置治疗老年患者颅内动脉瘤，术中并发症较少，短期临床疗效较好。
Abstract：Objective To investigate the safety and clinical efficacy of PED in the treatment of intracranial aneurysms in elderly patients.Methods The clinical data of 30 elderly patients(39 aneurysms) with intracranial aneurysms who were treated with PED in the Department of Neurology of the First Medical Center of Chinese PLA General Hospital from October 2018 to October 2022 were retrospectively analyzed.The occlusion of intracranial aneurysms was evaluated using the OKM grading scale.The clinical prognosis of elderly patients at discharge and during follow-up was assessed with the mRS.Results Totally 34 PEDs was implanted in the 30 patients, with a procedure success rate of 100%.DSA indicated that there were 29(74.4%) of OKM grade A,10(25.6%) of grade B,0 of grade C,and 0 of grade D immediately after PED implantation.The good prognosis rate(with mRS score ranging from 0 to 2) was 96.7% at discharge.Among the 21 aneurysms(14 patients) receiving DSA during follow-up, 19(90.5%) obtained aneurysm reduction and 12(57.1%) aneurysm occlusion(OKM grade C+D),and no aneurysm recurrence or enlargement, stent restenosis or neurological symptoms was observed.All the 30 patients were followed up by telephone for a median follow-up time of 9 months, and the good prognosis rate was 100.0%.Conclusion PED for intracranial aneurysms in elderly patients has advantages of less intraoperative complications and good short-term efficacy.
[1] Texakalidis P,Sweid A,Mouchtouris N,et al.Aneurysm formation,growth,and rupture:the biology and physics of cerebral aneurysms[J].World Neurosurg,2019,130:277-284.DOI:10.1016/j.wneu.2019.07.093.
[2] Hironaka K,Aso S,Suzuki M,et al.Outcomes in elderly Japanese patients treated for aneurysmal subarachnoid hemorrhage:a retrospective nationwide study[J].J Stroke Cerebrovasc Dis,2020,29(6):104795.DOI:10.1016/j.jstrokecerebrovasdis.2020.104795.
[3] Etminan N,Chang HS,Hackenberg K,et al.Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region,time period,blood pressure,and smoking prevalence in the population:a systematic review and meta-analysis[J].JAMA Neurol,2019,76(5):588-597.DOI:10.1001/jamaneurol.2019.0006.
[4] Nieuwkamp DJ,Setz LE,Algra A,et al.Changes in case fatality of aneurysmal subarachnoid haemorrhage over time,according to age,sex,and region:a meta-analysis[J].Lancet Neurol,2009,8(7):635-642.DOI:10.1016/S1474-4422(09)70126-7.
[5] 吕斌，王君，杜志华，等.80岁以上高龄颅内动脉瘤破裂患者神经介入治疗体会[J].中华老年心脑血管病杂志，2021,23(6):625-628.DOI:10.3969/j.issn.1009-0126.2021.06.018.
[6] Enriquez-Marulanda A,Penumaka A,Ogilvy CS,et al.Safety and efficacy of the off-label use of pipeline embolization device based on the 2018 food and drug administration-approved indications for intracranial aneurysms:a single-center retrospective cohort study[J].Neurosurgery,2022,90(6):700-707.DOI:10.1227/neu.0000000000001891.
[7] 中国医师协会神经介入专业委员会出血性脑血管病神经介入专业委员会(学组),中国医师协会神经外科医师分会神经介入专业委员会，中国医师协会介入医师分会神经介入专业委员会.血流导向装置治疗颅内动脉瘤的中国专家共识[J].中华神经外科杂志，2020,36(5):433-445.DOI:10.3760/cma.j.cn112050-20200229-00089.
[8] Yang H,Jiang H,Ni W,et al.Treatment strategy for unruptured intracranial aneurysm in elderly patients:coiling,clipping,or conservative?[J].Cell Transplant,2019,28(6):767-774.DOI:10.1177/0963689718823517.
[9] 黄豪，何朝晖.老年颅内未破裂动脉瘤的治疗及预后分析[J].重庆医科大学学报，2020,45(10):1405-1409.DOI:10.13406/j.cnki.cyxb.002566.
[10] Wahood W,Rizvi AA,Alexander AY,et al.Trends in admissions and outcomes for treatment of aneurysmal subarachnoid hemorrhage in the United States[J].Neurocrit Care,2022,37(1):209-218.DOI:10.1007/s12028-022-01476-5.
[11] Liu Q,Zhang Y,Yang J,et al.The relationship of morphological-hemodynamic characteristics,inflammation,and remodeling of aneurysm wall in unruptured intracranial aneurysms[J].Transl Stroke Res,2022,13(1):88-99.DOI:10.1007/s12975-021-00917-1.
[12] Olijnyk L,Darsaut TE,?hman J,et al.Understanding the importance of the primary trial hypothesis:the randomized trial on the timing of ruptured aneurysm surgery[J].Neurochirurgie,2022,68(5):474-477.DOI:10.1016/j.neuchi.2022.02.003.
[13] 中国医师协会神经介入专业委员会，中国颅内动脉瘤计划研究组.中国颅内未破裂动脉瘤诊疗指南2021[J].中国脑血管病杂志，2021,18(9):634-664.DOI:10.3969/j.issn.1672-5921.2021.09.008.
[14] Lauzier DC,Cler SJ,Chatterjee AR,et al.The value of long-term angiographic follow-up following Pipeline embolization of intracranial aneurysms[J].J Neurointerv Surg,2022,14(6):585-588.DOI:10.1136/neurintsurg-2021-017745.
[15] Cai H,Yang F,Xu Y,et al.A multicenter retrospective controlled study of the PipelineTM and TubridgeTM Flow Diverter devices for intracranial wide-necked aneurysms[J].Front Neurol,2022,13:1014596.DOI:10.3389/fneur.2022.1014596.
[16] Brasiliense LBC,Aguilar-Salinas P,Miller DA,et al.Analysis of predictors and probability of aneurysm occlusion in the internal carotid artery after treatment with pipeline embolization device[J].World Neurosurg,2017,107:641-648.DOI:10.1016/j.wneu.2017.08.099.
[17] Panchendrabose K,Muram S,Mitha AP.Promoting endothelialization of flow-diverting stents:a review[J].J Neurointerv Surg,2021,13(1):86-90.DOI:10.1136/neurintsurg-2020-015874.
[18] Brasiliense LBC,Aguilar-Salinas P,Lopes DK,et al.Multicenter study of pipeline flex for intracranial aneurysms[J].Neurosurgery,2019,84(6):E402-E409.DOI:10.1093/neuros/nyy422.
[19] Piano M,Trombatore P,Lozupone E,et al.Flow diverter devices in the treatment of anterior communicating artery region aneurysms:would the regional anatomy and the aneurysm location affect the outcomes?[J].Brain Sci,2022,12(11):1524.DOI:10.3390/brainsci12111524.
基本信息:
中图分类号:R651.12
引用信息:
[1]孙明广,江海松,周华,等.Pipeline血流导向装置治疗老年颅内动脉瘤患者的安全性及疗效分析[J].中华老年心脑血管病杂志,2023,25(04):353-356.
2023-04-14
2023-04-14