摘要
目的探讨可解脱微导管结合近端血流阻断增压技术(PCT)栓塞脑动静脉畸形(bAVM)的疗效及并发症。方法前瞻性队列研究2016年1月至2018年12月冬雷脑科医生集团上海浦南医院采用Onyx胶经动脉途径栓塞治疗bAVM患者133例,其中Spetzler-Martin分级Ⅰ级10例,Ⅱ级54例,Ⅲ级49例,Ⅳ级18例,Ⅴ级2例。按时间段将患者分为A组(n=70,2016年1月至2018年2月结合非解脱微导管)、B组(n=63,2018年3月至12月结合Apollo可解脱微导管),对B组中30例采用PCT。分析两组患者疗效及并发症发生率等。结果 133例患者bAVM总栓塞率为33.8%(45/133);A组栓塞率为25.7%(18/70),B组为49.2%(31/63),差异有显著统计学意义(P<0.01);B组中PCT技术组栓塞率为66.7%(20/30),非PCT技术组为33.3%(11/33),差异有统计学意义(P<0.05)。并发症发生在A组为5.7%(术中微导管粘管1例,术中出血1例,术后出血2例,其中1例死亡),B组为4.8%(术后出血3例,其中1例转外科手术)(P>0.05),总体并发症发生率为5.3%,无新发神经功能障碍。132例患者随访3~26个月(平均8个月),再发出血3例,其中1例死亡,完全栓塞患者无一例复发或再生血管畸形。131例患者中改良Rankin量表(mRS)评分0~1分106例,2分25例。结论经动脉途径采用Apollo可解脱微导管结合PCT技术栓塞治疗bAVM,可在不增加相关并发症情况下提高栓塞治愈率。
Objective To discuss the curative effect and complications of detachable tip microcatheter combined with pressure cooker technology(PCT) in interventional embolization for brain arteriovenous malformation(bAVM). Methods A prospective cohort study including 133 patients with bAVM, who were treated with Onyx glue embolization via arterial access at Shanghai Punan Hospital of Donglei Brain Doctor Group of China during the period from January 2016 to December 2018, was conducted. Of the 133 patients, Speztler-Martin(S-M) grade Ⅰ was seen in 10, grade Ⅱ in 54, grade Ⅲ in 49, grade Ⅳ in 18 and grade Ⅴ in 2. According to the time period during which the patient received treatment, the patients were divided into group A(n=70, from January 2016 to February 2018, using non-detachable microcatheter) and group B(n=63, from March 2018 to December 2018, using Apollo detachable tip microcathether). PCT technique was employed in treating 30 patients of group B. The curative effect and complications were compared between the two groups. Results The overall embolization rate in 133 patients was 34%(45/133), which was 25.7%(18/70) in group A and 49.2%(31/63) in group B, the difference between the two groups was statistically significant(P<0.01). In group B, the embolization rate in the patients receiving PCT technique was 66.7%(20/30) and in the patients not receiving PCT technique was 33.3%(11/33), the difference between the two groups was statistically significant(P<0.05). The incidence of complications in group A was 5.7%, including adhesion of microcatheter to vascular wall(n=1), intraoperative bleeding(n=1) and postoperative hemorrhage(n=2, one of them died). The incidence of complications in group B was 4.8%(n=3), all the 3 patients developed postoperative hemorrhage and one of them had to receive surgery. The difference in the incidence of complications between the two groups was not statistically significant(P>0.05). The overall incidence of complications was 5.3%. No newly-developed neurological dysfunction occur
作者
王威
盖延廷
檀书斌
彭方强
孙伟
刘旻谛
叶宇阳
宋冬雷
WANG Wei;GAI Yanting;TAN Shubing;PENG Fangqiang;SUN Wei;LIU Mingdi;YE Yuyang;SONG Donglei(Department of Neurosurgery,Punan Hospital of Pudong New District,Shanghai 200125,China)
出处
《介入放射学杂志》
CSCD
北大核心
2020年第4期345-349,共5页
Journal of Interventional Radiology
基金
上海市浦东新区医学学科建设项目(临床高原学科神经外科pwygy2018-04)。
