| 50 | 0 | 151 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨老年患者颅内囊状动脉瘤(intracranial saccular aneurysm, ISA)血管内弹簧圈栓塞后的复发风险因素及处理方案。方法 回顾性纳入2017年1月至2023年12月浙江省人民医院毕节医院神经外科接受血管内弹簧圈栓塞治疗的年龄≥60岁ISA患者204例，根据有无动脉瘤复发分为复发组32例和未复发组172例。复发组复发动脉瘤分型包括Ⅰ型10例、Ⅱ型7例、Ⅲ型13例、Ⅳ型2例。采用多因素logistic回归分析动脉瘤复发的危险因素，采用ROC曲线分析确定预测模型的预测能力。结果 复发组与未复发组术后即刻改良Raymond-Roy分级(modified Raymond-Roy classification, MRRC)比较，差异有统计学意义(P=0.007),复发组动脉瘤最大直径≥10 mm、术后即刻MRRCⅢb级栓塞、栓塞体积比(volume embolization ratio, VER)<20%比例显著高于未复发组，术后即刻MRRCⅠ级、支架辅助比例明显低于未复发组(P<0.05,P<0.01)。多因素logistic回归分析显示，动脉瘤最大直径≥10 mm、术后MRRCⅢb级和VER<20%是ISA复发的独立危险因素(P<0.05,P<0.01)。基于上述回归结果构建列线图模型，该模型预测动脉瘤复发风险的ROC曲线下面积为0.750(95%CI:0.680～0.803,P<0.01)。Ⅲ型、Ⅳ型复发患者动脉瘤最大直径≥10 mm、VER<20%比例明显高于Ⅰ型、Ⅱ型复发动脉瘤患者(P<0.05)。Ⅲ型和Ⅳ型动脉瘤复发患者复发后均接受了血管内再治疗。结论 动脉瘤直径较大、术后即刻MRRCⅢb级、VER较低是接受弹簧圈栓塞的老年ISA患者复发风险的独立危险因素。此外，建议对复发性Ⅲ型或Ⅳ型动脉瘤患者立即进行再治疗。
Abstract：Objective To explore the risk factors for recurrence of intracranial ruptured cystic aneurysm(ISA) in elderly patients after endovascular coil embolization and provide corresponding management strategies.Methods A retrospective analysis was conducted on 204 ISA patients(≥60 years old) receiving endovascular coiling in Bijie Branch of Zhejiang Provincial People's Hospital from January 2017 to December 2023.According to the presence of aneurysm recurrence or not, they were divided into a recurrence group(32 cases) and a non-recurrence group(172 cases).The recurrent aneurysms included 10 cases of type Ⅰ,7 cases of type Ⅱ,13 cases of type Ⅲ,and 2 cases of type Ⅳ.Multivariate logistic regression analysis was used to identify the risk factors for arterial aneurysm recurrence, and ROC curve analysis was used to determine the predictive performance of our model.Results There was significant difference in the occlusion classes of Modified Raymond-Roy Classification(MRRC) immediately after surgery between the recurrence group and the non-recurrence group(P=0.007).The recurrence group had obviously larger proportions of recurrent aneurysms with a maximum diameter of ≥10 mm, immediate MRRC occlusion classes Ⅱ～Ⅲb, and volume embolization ratio(VER) <20%,and lower ratios of immediate MRRC occlusion class Ⅰ and using stent assisted techniques when compared with the non-recurrent group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that maximum diameter of aneurysm ≥10 mm, postoperative MRRC occlusion class Ⅲb, and VER <20% were independent risk factors for ISA recurrence(P<0.05,P<0.01).The patients with types Ⅲ and Ⅳ recurrent aneurysms had increased ratios of maximum diameter of aneurysm ≥10 mm and VER <20% than those with types Ⅰ and Ⅱ(P<0.05).The patients with recurrent type Ⅲ and Ⅳ aneurysms received endovascular treatment after recurrence.Conclusion Larger diameter of aneurysm, MRRC grade Ⅲb immediately after surgery, and lower VER are independent risk factors for ISA recurrence in elderly patients undergoing coil embolization.In addition, it is recommended that the patients with recurrent type Ⅲ or Ⅳ aneurysms should undergo immediate re-treatment.
[1]Deshmukh AS,Priola SM,Katsanos AH,et al.The management of intracranial aneurysms:current trends and future directions[J].Neurol Int,2024,16(1):74-94.DOI:10.3390/neurolint1601000 5.
[2]Clarke H,Nefale T,Mngomezulu V.Endovascular management of intracranial aneurysms at Chris Hani BaragwanathAcademic Hospital[J].SA J Radiol,2023,27(1):2634.DOI:10.4102/sajr.v27i1.2634.
[3]Chen Y,Wu J,Yuan W,et al.The rupture risk of intracranial saccular aneurysm:a case-control study based on a threedimensional computed tomography angiography model[J].Quant Imaging Med Surg,2024,14(5):3339-3349.DOI:10.21037/qims-23-1694.
[4]Ding Y,Hu J,Zhou B,et al.Comparative effectiveness of therapies in 2665 elderly patients with ruptured intracranial aneurysms[J].Neurol India,2024,72(4):734-741.DOI:10.4103/neurol-india.Neurol-India-D-23-00505.
[5]Cho YH,Choi J,Huh CW,et al.Imaging follow-up strategy after endovascular treatment of intracranial aneurysms:a literature review and guideline recommendations[J].J Cerebrovasc Endovasc Neurosurg,2024,26(1):1-10.DOI:10.7461/jcen.2024.E2023.08.008.
[6]Lee KS,Zhang JJY,Nguyen V,et al.The evolution of intracranial aneurysm treatment techniques and future directions[J].Neurosurg Rev,2022,45(1):1-25.DOI:10.1007/s10143-021-01543-z.
[7]Pierot L,Barbe C,Thierry A,et al.Patient and aneurysm factors associated with aneurysm recanalization after coiling[J].J Neurointerv Surg,2022,14(11):1096-1101.DOI:10.1136/neurintsurg-2021-017972.
[8]Wisniewski K,Tyfa Z,Tomasik B,et al.Risk Factors for re canalization after coil embolization[J].J Pers Med,2021,11(8):793.DOI:10.33 90/jpm110807 93.
[9]王欣然,胡斌,施昭,等.CT血管成像形态学及血流动力学参数预测颅内动脉瘤经血管内栓塞治疗后复发[J].中国医学影像技术,2025,41(1):9-14.DOI:10.13929/j.issn.1003-3289.2025.01.003.
[10]Nambu I,Misaki K,Uno T,et al.Recurrence pattern predicts aneurysm rupture after coil embolization[J].PLoS One,2022,17(9):e0261996.DOI:10.1371/journal.pone.0261996.
[11]王涛,张昊,邢以嵩.颅内动脉瘤再次栓塞术后复发的影响因素分析[J].中国临床神经外科杂志,2023,28(10):621-624.DOI:10.13798/j.issn.1009-153X.2023.10.004.
[12]Fukuda H,Hyohdoh Y,Kawada K,et al.Risk factors of shortterm poor functional outcomes and long-term durability of ruptured large or giant intracranial aneurysms[J].J Neurosurg,2025,142(6):1776-1785.DOI:10.3171/2024.8.JNS24894.
[13]Lin S,Zou Y,Hu J,et al.Development and assessment of machine learning models for predicting recurrence risk after endovascular treatment in patients with intracranial aneurysms[J].Neurosurg Rev,2022,45(2):1521-1531.DOI:10.1007/s10143-021-01665-4.
[14]Gu W,Zhou G,Aldiyarova A,et al.Stent-assisted coiling of intracranial carotid ophthalmic segment aneurysm segment aneurysms;long-term follow-up from a single center[J].J Interv Med,2023,6(3):116-120.DOI:10.1016/j.jimed.2023.07.004.
[15]Li G.Recurrence rate of intracranial aneurysms:a systematicreview and a meta-analysis comparing craniotomy and endovascular coiling[J].Neurosurg Rev,2025,48(1):80.DOI:10.1007/s10143-025-03183-z.
[16]Zhong W,Zhang T,Su C,et al.Reconstructive endovascular treatment for basilar artery trunk aneurysms:complications and clinical and angiography outcomes[J].J Neurointerv Surg,2023,15(12):1194-12:00.DOI:10.113 6/jnis-2022-019864.
[17]孙奇,王翼,边世春,等.颅内破裂动脉瘤治疗策略与预后影响因素:单中心1572例倾向性评分匹配分析[J].中国临床神经外科杂志,2023,28(12):673-677.DOI:10.13798/j.issn.1009-153X.2023.12.001.
[18]Khumtong Thuncharoenkankha T,Riabroi K,et al. Changes in modified raymond-roy classification occlusion classes and predictors of recurrence-free survival in patients with intracranial aneurysms after endovascular coil embolization[J].J Vasc Interv Radiol,2023,34(4):685-693.DOI:10.1016/j.jvir.2022.12.028.
[19]Kim MJ,Chung J,Park KY,et al.Recurrence and risk factors of posterior communicating artery aneurysms after endovascular treatment[J].Acta Neurochir(Wien),2021,163(8):2319-2326,DOI:10.1007/s00701-021-04881-5.
[20]Greve T,Sukopp M,Wostrack M,et al.Initial raymond-roy occlusion classification but not packing density defines risk for recurrence after aneurysm coiling[J].Clin Neuroradiol,2021,31(2):391-399.DOI:10.1007/s0 0062-020-00926-x.
[21]Caffes N,Weng er N,Cannarsa G,et al.Unruptured cerebral aneurysms in elderly patients:key challenges and management[J].Ann Med,2021,53(1):1839-1849.DOI:10.1080/07853890.2021.1990393.
[22]Karadeli HH,Kuram E.Single component polymers,polymer blends,and polymer composites for interventional endovascular embolization of intracranial aneurysms[J].Macromol Biosci,2024,24(5):e2300432.DOI:10.1002/mabi.202300432.
[23]Wu D,Sheng B,Fang X,et al.Risk factors of recurrence after endovascular embolization of posterior communicating artery aneurysms[J].Interv Neuroradiol,2022,28(5):562-567.DOI:10.1177/15910199211054715.
[24]Li G.Recurrence rate of intracranial aneurysms:a systematic review and a meta-analysis comparing craniotomy and endovascular coiling[J].Neurosurg Rev,2025,48(1):80.DOI:10.1007/s1043-025-03183-z.
[25]Paz C,Suárez E,Cabarcos A,et al.Numerical study of a thrombus migration risk in aneurysm after coil embolization in patient cases:FSI modelling[J].Car diova sc Eng Technol,2023,14(4):544-559.DOI:10.1007/s13239-023-00672-4.
[26]Nie X,Yang Y,Liu Q,et al.A deep-learning system to help make the surgical planning of coil embolization for unruptured intracranial aneurysms[J].Chin Neurosurg J,2023,9(1):24.DOI:10.1186/s41016-023-00339-y.
基本信息:
中图分类号:R743.35
引用信息:
[1]沈路,龙天霖,吴博,等.老年颅内破裂囊状动脉瘤弹簧圈栓塞后复发风险因素分析与处理[J].中华老年心脑血管病杂志,2025,27(07):920-924.
基金信息:
毕节市科技计划项目[毕科合字(13)59号]
2025-07-15
2025-07-15