血流导向装置与支架辅助弹簧圈治疗颅内夹层动脉瘤的临床疗效及预后分析

Clinical Outcomes and Prognostic Analysis of Flow Diverter versus Stent-Assisted Coil Embolization for Intracranial Dissecting Aneurysms

摘要: 目的：探讨血流导向装置(FD)与传统支架辅助弹簧圈(SAC)在治疗颅内夹层动脉瘤(intracranial dissecting aneurysm, IDA)中的安全性和有效性。方法：回顾性分析北华大学附属医院神经外科2019年9月~2024年9月期间收治并采用血管内介入技术治疗的38例颅内夹层动脉瘤患者的临床资料，记录患者基本资料、临床症状、手术方式、围术期并发症与手术时间等信息。以动脉瘤显影水平评估栓塞程度、改良Rankin量表(mRS)评估预后，评估两种手术方式的安全性和有效性。结果：38例患者均成功接受治疗，其中16例患者接受Fd治疗，22例接受SAC治疗。共植入16枚Fd，其中4例患者接受单纯Fd治疗，12例患者接受Fd联合弹簧圈栓塞治疗，围术期发生缺血性并发症2例(12.5%)，为急性血栓形成，予以溶栓对症处理，术后恢复尚可；植入22枚传统支架，其中2例患者接受单纯支架治疗，20例患者接受SAC治疗，围手术期缺血并发症3例(13.6%)。Fd组14例获得随访，DSA复查显示完全栓塞13例，不全栓塞1例；SAC组18例患者获得随访，DSA复查显示完全栓塞11例，不全栓塞7例，其中2例复发，1例再次栓塞，1例考虑相对稳定，继续随访观察。结论：统计学分析显示，术后梗死、术后出血、术后肺部感染、脑积水等围手术期并发症发生率(P > 0.05)方面未发现明显统计学差异。FD组的手术时长明显短于传统支架组(P = 0.031)、动脉瘤完全闭塞率(P = 0.047)，有统计学差异。FD治疗的动脉瘤手术时间短、闭塞率较高，效果良好、安全性好，但围手术期并发症仍需注意防治。

Abstract: Objective: To evaluate the safety and efficacy of flow diverter (FD) devices versus conventional stent-assisted coiling (SAC) in the treatment of intracranial dissecting aneurysms (IDA). Methods: A retrospective review was conducted of clinical data from 38 patients with IDA who underwent endovascular intervention at the Department of Neurosurgery, Affiliated Hospital of Beihua University, between September 2019 and September 2024. Patient demographics, presenting symptoms, procedural techniques, perioperative complications, and operative duration were recorded. Aneurysm occlusion was assessed according to angiographic visualization. Functional outcomes were evaluated using the modified Rankin Scale (mRS). The safety and efficacy of FD and SAC were compared. Results: All 38 patients underwent successful endovascular treatment, including 16 patients in the FD group and 22 in the SAC group. Sixteen FD devices were implanted: four patients received FD alone, and twelve received FD combined with coil embolization. Ischemic complications occurred in two patients (12.5%) in the FD group due to acute thrombus formation; all were managed with thrombolysis and recovered satisfactorily postoperatively. In the SAC group, 22 stents were implanted: two patients received stent-only treatment, and twenty underwent SAC. Ischemic complications were observed in three cases (13.6%). Fourteen patients in the FD group completed follow-up; digital subtraction angiography (DSA) demonstrated complete occlusion in thirteen cases and incomplete occlusion in one case. Eighteen patients in the SAC group were followed; DSA revealed complete occlusion in eleven cases and incomplete occlusion in seven cases, among which two experienced recurrence, one underwent repeat embolization, and one remained stable under observation. Conclusion: Statistical analysis showed no significant differences between FD and SAC groups in perioperative complication rates, including postoperative infarction, hemorrhage, pulmonary infection, or hydrocephalus (P > 0.05). However, the FD group showed significantly shorter operative duration (P = 0.031) and higher complete occlusion rates (P = 0.047) compared with the SAC group. FD treatment for IDA offers shorter procedure times and higher aneurysm occlusion rates, with favorable safety and efficacy profiles, although vigilance for perioperative complications remains essential.