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血管内治疗后颅内动脉瘤患者血管造影即时结果的影响因素

Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment.

作者信息

Chen Jia-Xiang, Lai Ling-Feng, Zheng Kuang, Li Guo-Xiong, He Xu-Ying, Li Liang-Ping, Duan Chuan-Zhi

机构信息

Department of Neurosurgery, Guangzhou Red Cross Hospital, The Fourth Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China.

Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Avenue, Haizhu District, Guangzhou, 510282, People's Republic of China.

出版信息

J Neurol. 2015 Sep;262(9):2115-23. doi: 10.1007/s00415-015-7824-2. Epub 2015 Jun 24.

Abstract

The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely.

摘要

本研究旨在分析血管内治疗(EVT)后颅内动脉瘤患者血管造影即刻结果的相关影响因素,为颅内动脉瘤的临床治疗提供理论依据和指导。共有529例患者符合纳入标准,其中男性338例,女性191例。仔细且完整地记录了性别、年龄、高血压、糖尿病和吸烟史、颅内动脉粥样硬化、破裂状态、大小和位置、瘤颈特征、形态、血管痉挛、治疗方式以及动脉瘤闭塞程度。所有数据均在单因素和多因素逻辑回归模型中进行研究,以确定它们是否与动脉瘤闭塞程度相关。根据动脉瘤大小,将动脉瘤分为微小动脉瘤、小型动脉瘤和大型动脉瘤。有451例窄颈动脉瘤和78例宽颈动脉瘤。共有417例形态规则,112例不规则。125例为未破裂动脉瘤;404例为破裂动脉瘤。治疗方式如下:单纯弹簧圈栓塞(n = 415)、支架辅助弹簧圈栓塞(n = 89)和球囊辅助弹簧圈栓塞(n = 25)。单因素分析显示,动脉瘤大小、瘤颈特征、形态和破裂状态可能影响EVT后的即刻闭塞情况。多因素逻辑回归分析表明,破裂动脉瘤、微小动脉瘤和宽颈动脉瘤是颅内动脉瘤完全闭塞的独立影响因素。动脉瘤破裂状态、大小、瘤颈特征和形态可能是EVT后颅内动脉瘤患者血管造影即刻结果的独立影响因素。未破裂、微小、窄颈和形态规则的动脉瘤更有可能完全闭塞。

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