Lvis和Solitaire支架辅助弹簧圈治疗未破裂宽颈眼动脉段动脉瘤的效果比较

俞国松; 阮善平; 赵志新; 胡小铭

doi:10.16766/j.cnki.issn.1674-4152.002634

Lvis和Solitaire支架辅助弹簧圈治疗未破裂宽颈眼动脉段动脉瘤的效果比较

doi: 10.16766/j.cnki.issn.1674-4152.002634

台州恩泽医疗中心(集团)浙江省台州医院神经外科，浙江台州 317000

基金项目:

浙江省基础公益研究计划项目 LGF19H090014

详细信息

通讯作者:
胡小铭, E-mail: huxm6002@163.com

中图分类号: R732.21 R730.56
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出版历程
- 收稿日期: 2021-09-27
- 网络出版日期: 2022-11-29

A comparative study of clinical efficacy and safety between Lvis and Solitaire stent-assisted embolization for unruptured wide-necked ophthalmic segment aneurysms of internal carotid artery

Department of Neurosurgery, Taizhou Hospital of Taizhou Enze Medical Centre (Group), Taizhou, Zhejiang 317000, China

摘要

摘要: 目的探讨比较Lvis和Solitaire支架辅助弹簧圈治疗未破裂宽颈眼动脉段动脉瘤的临床疗效及安全性。方法回顾性分析2018年3月—2019年7月在浙江省台州医院应用Lvis或Solitaire支架辅助弹簧圈栓塞的53例未破裂宽颈颈内动脉眼动脉段动脉瘤患者的临床资料，其中Lvis组29例，Solitaire组24例。应用术毕即刻栓塞程度(Raymond分级)和术后6~12个月数字减影血管造影(DSA)随访结果比较2组的手术疗效，手术相关并发症发生情况比较2组的手术安全性。结果术后即刻造影结果显示，Lvis组术后即刻达RaymondⅠ级的有24例(82.8%)，Ⅱ级5例(17.2%)，Solitaire组Ⅰ级17例(70.8%)，Ⅱ级6例(25.0%)，另外有1例(4.2%)为Ⅲ级，2组比较差异无统计学意义(P>0.05)。术后6~12个月DSA随访结果显示，Lvis组显著优于Solitaire组(P < 0.05)。Lvis组手术相关并发症发生率为13.8%(4/29)，高于Solitaire组的4.2%(1/24)。结论 Lvis和Solitaire两种支架在辅助弹簧圈栓塞治疗未破裂宽颈眼动脉段动脉瘤中各有优劣。Lvis支架可能更有利于减少远期复发，而Solitaire支架有更低的并发症发生率。
- Lvis支架 /
- 未破裂 /
- 眼段 /
- 宽颈动脉瘤 /
- Solitaire支架
Abstract: Objective To compare the clinical efficacy and safety of Lvis and Solitaire stent-assisted embolization in the treatment of unruptured wide-necked ophthalmic segment aneurysms of internal carotid artery. Methods The clinical data of 53 patients with unruptured wide-necked ophthalmic segment aneurysms treated by Lvis or Solitaire stent-assisted embolization from March 2018 to July 2019 in Taizhou Hospital of Zhejiang Province were analysed retrospectively. A total of 29 patients were treated with Lvis stents, whereas 24 were treated with Solitaire stents. The surgical efficacy of the two groups was compared by Raymond classification based on immediate postoperative angiography, and follow-up results were based on digital subtraction angiography (DSA) at 6 - 12 months. The incidence of perioperative complications was used to compare the safety of the two groups. Results Statistical analysis showed no significant differences in patients after the procedure in the instant Raymond classification (P>0.05). DSA immediately after the embolization showed that 24 (82.8%) received Raymond grade Ⅰ and 5 (17.2%) were Raymond grade Ⅱ in the Lvis stent group, whereas 17 (70.8%) received Raymond grade Ⅰ, 6 (25.0%) received Raymond grade Ⅱ and 1 (4.2%) received Raymond grade Ⅲ. The follow-up results based on DSA at 6 - 12 months in the Lvis stent group were better than those in the Solitaire stent group, and the difference was statistically significant (P < 0.05). The incidence of surgery-related complications in the Lvis stent group was 13.8% (4/29), which was higher than 4.2% (1/24) in the Solitaire stent group. Conclusion Lvis stent and Solitaire stent-assisted coil embolization have their own advantages and disadvantages in the treatment of unruptured wide-necked ophthalmic segment aneurysms of the internal carotid artery. Lvis stent-assisted embolization for unruptured wide-necked ophthalmic segment aneurysm is beneficial to decrease recurrence rate, whereas Solitaire stent has a good safety level.
- Lvis stent /
- Unruptured /
- Ophthalmic segment /
- Wide-necked aneurysm /
- Solitaire stent

HTML全文

图 1 1例未破裂眼动脉段宽颈动脉瘤患者Lvis支架辅助弹簧圈栓塞术前、术中及术后影像

注：A为栓塞前三维图像，白色箭头示未破裂眼动脉段宽颈动脉瘤，大小约8.2 mm×6.4 mm，瘤颈约5.1 mm；B为栓塞术中工作角度，Lvis支架半释放状态下(黑色箭头所示)弹簧圈填塞动脉瘤(白色箭头所示)；C为栓塞术后工作角度，动脉瘤致密栓塞(白色箭头所示)，达Raymond Ⅰ级，载瘤动脉通畅(黑色箭头所示)；D为术后7个月复查DSA三维图像，动脉瘤基本治愈(白色箭头所示)。

Figure 1. Preoperative, intraoperative and postoperative images of a patient with unruptured wide-necked ophthalmic artery segment aneurysm treated with Lvis stent-assisted coil embolization

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表 1 2组未破裂宽颈颈内动脉眼动脉段动脉瘤患者临床资料比较

Table 1. Comparison of clinical data between two groups of patients with unruptured wide-necked internal carotid artery aneurysms

组别	例数	年龄(x±s, 岁)	性别(例)		瘤体大小(例)
组别	例数	年龄(x±s, 岁)	男性	女性	小	中	大	巨大
Lvis组	29	58.1±11.0	10	19	19	9	1	0
Solitaire组	24	57.7±9.4	8	16	15	9	0	0
统计量		0.154^a	0.008^b		0.128^c
P值		0.878	0.930		0.898
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组未破裂宽颈颈内动脉眼动脉段动脉瘤患者术后即刻造影Raymond分级比较(例)

Table 2. Comparison of Raymond grade of immediate postoperative angiography in two groups of patientswith unruptured wide-necked internal carotid artery aneurysms (cases)

组别	例数	Ⅰ级	Ⅱ级	Ⅲ级
Lvis组	29	24	5	0
Solitaire组	24	17	6	1
注：2组Raymond分级比较，Z=-1.082，P=0.279。

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表 3 2组未破裂宽颈颈内动脉眼动脉段动脉瘤患者术后6~12个月DSA复查结果比较(例)

Table 3. Comparison of DSA review results between the two groups of patients with unruptured wide-necked internal carotid artery ophthalmic artery aneurysms 6 - 12 months after surgery (cases)

组别	例数	治愈	改善	稳定	复发
Lvis组	29	27	2	0	0
Solitaire组	24	17	1	4	2
注：2组DSA复查结果比较，Z=-2.282，P=0.022。

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