脑动脉瘤颈部直径对支架辅助弹簧圈栓塞术后进行性脑血管闭塞发生的预测价值
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摘要
目的探讨脑动脉瘤经支架辅助弹簧圈栓塞术治疗后不完全性闭塞出现进行性脑血管闭塞的预测因素。方法回顾性连续纳入于2012年1月至2015年12月在榆林市第一医院神经外科接受支架辅助弹簧圈栓塞术并经术中即刻血管造影提示为不完全性闭塞的92例脑动脉瘤患者,并依据术后6个月全脑血管造影随访结果,分为进行性闭塞组(59例)与未闭塞组(33例)。利用双平面造影系统和三维旋转造影系统采集患者术后即刻和术后6个月的多维度血管造影图像,并通过Raymond分级标准对所有患者的血管造影结果进行分级评估。采用多因素Logistics回归分析、受试者工作特征(ROC)曲线评估进行性脑血管闭塞的预测因素。结果进行性闭塞组患者脑动脉瘤平均最大直径[(6.6±2.9) mm]和平均颈部直径[(4.9±1.0) mm]均小于未闭塞组患者[分别为(8.5±2.4)、(6.2±1.2) mm],差异均有统计学意义(t值分别为-3.196、-5.561,均P <0.01)。多因素Logistic回归分析结果表明,脑动脉瘤的颈部直径是进行性脑血管闭塞的独立影响因素(OR=0.44,95%CI:0.18～0.79,P=0.030); ROC曲线分析结果表明,颈部直径预测进行性脑血管闭塞的截断值为5.8 mm(特异度为82.1%,敏感度为75.8%),曲线下面积为0.847 (P <0.01)。结论脑动脉瘤颈部直径是支架辅助弹簧圈栓塞术后出现进行性脑血管闭塞的独立因素,颈部直径<5.8 mm的脑动脉瘤患者在支架辅助弹簧圈栓塞术治疗后6个月内更易自发性出现进行性脑血管闭塞。
Objective To investigate the predictive factors of developing progressive cerebrovascular occlusion in incomplete occlusion after cerebral aneurysms treated with stent-assisted coil embolization.Methods Ninety-two consecutive patients with cerebral aneurysm received stent-assisted coil embolization and immediate intraoperative angiography revealed incomplete occlusion at the Department of Neurosurgery,Yulin First Hospital from January 2012 to December 2015 were enrolled retrospectively.According to the follow-up results of angiography 6 months after operation,the patients were divided into progressive occlusion group( n = 59) and non-occlusion group( n = 33).Multi-dimensional angiographic images of patients immediately and 6 months after surgery were collected using a biplane angiography system and a threedimensional rotational angiography system,and the angiographic results of all patients were graded by the Raymond grading criteria.Predictors of progressive cerebrovascular occlusion were assessed using multivariate logistic regression analysis and receiver operating characteristic( ROC) curves.Results The mean maximum diameter of cerebral aneurysms( 6.6 ± 2.9 mm) and mean neck diameter( 4.9 ± 1.0 mm) in the progressive occlusion group were less than those in the non-occlusion group( 8.5 ± 2.4 mm and 6.2 ± 1.2 mm respectively).The differences were statistically significant.( t =-3.196 and-5.661 respectively,all P <0.01).Multivariate logistic regression analysis showed that the neck diameter of cerebral aneurysms was an independent influencing factor for progressive cerebrovascular occlusion( OR,0.44,95% CI 0.18-0.79,P = 0.030).The cut-off value of neck diameter for predicting cerebrovascular occlusion was 5.8 mm( specificity 82.1%,sensitivity 75.8%,and the area under curve 0.847,P < 0.01).Conclusions The neck diameter of cerebral aneurysms was an independent predictor for progressive cerebrovascular occlusion after stent-assisted coil embolization.Patients with cerebral aneurysms < 5.8 mm in neck diameter were more likely to spontaneously develop cerebrovascular occlusion within 6 months after stent-assisted coil embolization.
Objective To investigate the predictive factors of developing progressive cerebrovascular occlusion in incomplete occlusion after cerebral aneurysms treated with stent-assisted coil embolization.Methods Ninety-two consecutive patients with cerebral aneurysm received stent-assisted coil embolization and immediate intraoperative angiography revealed incomplete occlusion at the Department of Neurosurgery,Yulin First Hospital from January 2012 to December 2015 were enrolled retrospectively.According to the follow-up results of angiography 6 months after operation,the patients were divided into progressive occlusion group( n = 59) and non-occlusion group( n = 33).Multi-dimensional angiographic images of patients immediately and 6 months after surgery were collected using a biplane angiography system and a threedimensional rotational angiography system,and the angiographic results of all patients were graded by the Raymond grading criteria.Predictors of progressive cerebrovascular occlusion were assessed using multivariate logistic regression analysis and receiver operating characteristic( ROC) curves.Results The mean maximum diameter of cerebral aneurysms( 6.6 ± 2.9 mm) and mean neck diameter( 4.9 ± 1.0 mm) in the progressive occlusion group were less than those in the non-occlusion group( 8.5 ± 2.4 mm and 6.2 ± 1.2 mm respectively).The differences were statistically significant.( t =-3.196 and-5.661 respectively,all P <0.01).Multivariate logistic regression analysis showed that the neck diameter of cerebral aneurysms was an independent influencing factor for progressive cerebrovascular occlusion( OR,0.44,95% CI 0.18-0.79,P = 0.030).The cut-off value of neck diameter for predicting cerebrovascular occlusion was 5.8 mm( specificity 82.1%,sensitivity 75.8%,and the area under curve 0.847,P < 0.01).Conclusions The neck diameter of cerebral aneurysms was an independent predictor for progressive cerebrovascular occlusion after stent-assisted coil embolization.Patients with cerebral aneurysms < 5.8 mm in neck diameter were more likely to spontaneously develop cerebrovascular occlusion within 6 months after stent-assisted coil embolization.
引文
[1]冯明陶,冯政哲,方亦斌,等.支架与非支架辅助弹簧圈栓塞治疗颅内动脉瘤的Meta分析[J].中国脑血管病杂志,2016,13(1):17-24.
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[6]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.
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[8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
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[10]Roy D,Milot G,Raymond J.Endovascular treatment of unruptured aneurysms[J].Stroke,2001,32(9):1998-2004.
[11]Fargen KM,Hoh BL,Welch BG,et al.Long-term results of enterprise stent-assisted coiling of cerebral aneurysms[J].Neurosurgery,2012,71(2):239-244.
[12]Lylyk P,Cohen JE,Ceratto R,et al.Endovascular reconstruction of intracranial arteries by stent placement and combined techniques[J].J Neurosurg,2002,97(6):1306-1313.
[13]Izar B,Rai A,Raghuram K,et al.Comparison of devices used for stent-assisted coiling of intracranial aneurysms[J].PLo S One,2011,6(9):e24875.
[14]Santillan A,Greenberg E,Patsalides A,et al.Long-term clinical and angiographic results of Neuroform stent-assisted coil embolization in wide-necked intracranial aneurysms[J].Neurosurgery,2012,70(5):1232-1237.
[15]李敏,王武,李明华,等.Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效[J].介入放射学杂志,2012,21(5):356-361.
[16]Piotin M,Blanc R,Spelle L,et al.Stent-assisted coiling of intracranial aneurysms:clinical and angiographic results in216 consecutive aneurysms[J].Stroke,2010,41(1):110-115.
[17]Pierot L,Cognard C,Anxionnat R,et al.Endovascular treatment of ruptured intracranial aneurysms:factors affecting midterm quality anatomic results:analysis in a prospective,multicenter series of patients(CLARITY)[J].AJNR Am J Neuroradiol,2012,33(8):1475-1480.
[18]Wu YF,Yang PF,Shen J,et al.A comparison of the hemodynamic effects of flow diverters on wide-necked and narrow-necked cerebral aneurysms[J].J Clin Neurosci,2012,19(11):1520-1524.
[19]Lopes D,Sani S.Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent[J].Neurosurgery,2005,56(2):E416.
[20]Dai D,Ding YH,Rezek I,et al.Characterizing patterns of endothelialization following coil embolization:a whole-mount,dual immunostaining approach[J].J Neurointerv Surg,2016,8(4):402-406.
[2]Maldonado IL,Machi P,Costalat V,et al.Neuroform stent-assisted coiling of unruptured intracranial aneurysms:short-and midterm results from a single-center experience with 68 patients[J].AJNR Am J Neuroradiol,2011,32(1):131-126.
[3]逄锦峰,纪祯龙,张爱荣.Neuroform自膨式支架辅助弹簧圈栓塞治疗颅内动脉瘤68例临床分析[J].中国老年学,2013,33(9):2022-2025.
[4]Hong Y,Wang YJ,Deng Z,et al.Stent-assisted coiling versus coiling in treatment of intracranial aneurysm:a systematic review and Meta-analysis[J].PLoS One,2014,9(1):e82311.
[5]Mine B,Aljishi A,D'Harcour JB,et al.Stent-assisted coiling of unruptured intracranial aneurysms:long-term follow-up in 164 patients with 183 aneurysms[J].J Neuroradiol,2014,41(5):322-328.
[6]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[9]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,16(10):15-35.
[10]Roy D,Milot G,Raymond J.Endovascular treatment of unruptured aneurysms[J].Stroke,2001,32(9):1998-2004.
[11]Fargen KM,Hoh BL,Welch BG,et al.Long-term results of enterprise stent-assisted coiling of cerebral aneurysms[J].Neurosurgery,2012,71(2):239-244.
[12]Lylyk P,Cohen JE,Ceratto R,et al.Endovascular reconstruction of intracranial arteries by stent placement and combined techniques[J].J Neurosurg,2002,97(6):1306-1313.
[13]Izar B,Rai A,Raghuram K,et al.Comparison of devices used for stent-assisted coiling of intracranial aneurysms[J].PLo S One,2011,6(9):e24875.
[14]Santillan A,Greenberg E,Patsalides A,et al.Long-term clinical and angiographic results of Neuroform stent-assisted coil embolization in wide-necked intracranial aneurysms[J].Neurosurgery,2012,70(5):1232-1237.
[15]李敏,王武,李明华,等.Neuroform3支架辅助弹簧圈栓塞脑宽颈动脉瘤的长期随访疗效[J].介入放射学杂志,2012,21(5):356-361.
[16]Piotin M,Blanc R,Spelle L,et al.Stent-assisted coiling of intracranial aneurysms:clinical and angiographic results in216 consecutive aneurysms[J].Stroke,2010,41(1):110-115.
[17]Pierot L,Cognard C,Anxionnat R,et al.Endovascular treatment of ruptured intracranial aneurysms:factors affecting midterm quality anatomic results:analysis in a prospective,multicenter series of patients(CLARITY)[J].AJNR Am J Neuroradiol,2012,33(8):1475-1480.
[18]Wu YF,Yang PF,Shen J,et al.A comparison of the hemodynamic effects of flow diverters on wide-necked and narrow-necked cerebral aneurysms[J].J Clin Neurosci,2012,19(11):1520-1524.
[19]Lopes D,Sani S.Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent[J].Neurosurgery,2005,56(2):E416.
[20]Dai D,Ding YH,Rezek I,et al.Characterizing patterns of endothelialization following coil embolization:a whole-mount,dual immunostaining approach[J].J Neurointerv Surg,2016,8(4):402-406.