标题：两种不同支架辅助弹簧圈栓塞治疗颅内动脉瘤的临床效果及对远期预后的影响

      作者：杜战锋，严亿军，崔旭波，曹亮，冯建东，赵敬智，高亚东    铜川市人民医院神经外科，陕西 铜川 727000

      卷次： 2023年34卷7期

      【摘要】 目的 探究两种不同支架辅助弹簧圈栓塞治疗颅内动脉瘤(IA)的临床效果及对患者远期预后的影响。方法 回顾性分析2019年2月至2021年3月铜川市人民医院收治的78例 IA患者的临床资料，根据其术中所用支架的不同将其分为Neuroform组40例和LVIS/LVIS Jr组38例，比较两组患者的临床疗效，以及手术前后的脑血灌注指标[患侧局部脑血容量(rCBV)、颅内压(ICP)]、神经营养标志物[神经生长因子(NGF)、S-100B蛋白]；术后随访1年，比较两组患者的远期预后[改良Rankin评分(mRS)、动脉瘤血管再通]及并发症发生情况。结果 LVIS/LVIS Jr组患者的治疗总有效率为97.37%，明显高于Neuroform组的82.50%，差异有统计学意义(P<0.05)；手术后，两组患者的 rCBV较手术前升高，且 LVIS/LVIS Jr组患者的 rCBV为(2.28±0.41) mL/100 g，明显高于Neuroform组的(1.97±0.37) mL/100 g，差异均有统计学意义(P<0.05)；手术后，两组患者的 ICP、NGF、S-100B蛋白水平较手术前降低，且LVIS/LVIS Jr组患者的ICP、NGF、S-100B蛋白水平分别为(19.85±1.17) mmHg、(47.36±6.22) μg/L、(0.72±0.12) μg/mL，明显低于Neuroform组的(22.18±1.95) mmHg、(50.34±5.96) μg/L、(0.79±0.15) μg/mL，差异均有统计学意义(P<0.05)；术后随访1年，LVIS/LVIS Jr组患者的mRS得分、动脉瘤血管再通率、支架内血栓率分别为(1.97±0.56)分 、2.63%、0，明显低于Neuroform组的(2.38±0.61)分、17.50%、10.00%，差异均有统计学意义(P<0.05)；LVIS/LVIS Jr组患者的弹簧圈逃逸、脑积水、载瘤动脉狭窄、脑血管痉挛发生率分别为 5.26%、0、5.26%、2.63%，与Neuroform组的 2.50%、2.50%、7.50%、5.00%比较差异均无统计学意义(P>0.05)。结论 LVIS/LVIS Jr支架应用于 IA栓塞治疗的效果更好，其可改善患者的颅内循环及神经功能，远期预后良好，且还可降低支架内血栓发生风险。
      【关键词】 颅内动脉瘤；弹簧圈栓塞；Neuroform支架；LVIS支架；LVIS Jr支架；临床效果；远期预后
      【中图分类号】 R739.41 【文献标识码】 A 【文章编号】 1003—6350（2023）07—0949—04

Clinical effects of two different stent-assisted coil embolization in the treatment of intracranial aneurysm andinfluence on long-term prognosis.
DU Zhan-feng, YAN Yi-jun, CUI Xu-bo, CAO Liang, FENG Jian-dong, ZHAOJing-zhi, GAO Ya-dong. Department of Neurosurgery, People's Hospital of Tongchuan, Tongchuan 727000, Shaanxi, CHINA
【Abstract】 Objective To explore the clinical effects of two different stent-assisted coil embolization in thetreatment of intracranial aneurysm (IA) and influence on long-term prognosis in patients. Methods The clinical data of78 patients with IA who were treated in People's Hospital of Tongchuan were retrospectively analyzed between February2019 and March 2021, and the patients were divided into Neuroform group (40 cases) and LVIS/LVIS Jr group (38 cases) ac-cording to the stents used in the surgery. The clinical efficacy, cerebral blood perfusion indicators [regional cerebralblood volume of affected side (rCBV), intracranial pressure (ICP)], and neurotrophic markers [nerve growth factor(NGF), S-100B protein] before and after surgery, as well as long-term prognosis [Modified Rankin Score (mRS), aneu-rysm recanalization] and occurrence of complications at 1 year of follow-up after surgery were compared between thetwo groups of patients. Results The effective rate in LVIS/LVIS Jr group was 97.37%, which was significantly higherthan 82.50% in Neuroform group. After surgery, the rCBV of the two groups was enhanced compared with that beforesurgery, and the rCBV in LVIS/LVIS Jr group was (2.28±0.41) mL/100 g, significantly higher than (1.97±0.37) mL/100 g inNeuroform group (P<0.05). The levels of ICP, NGF, and S-100B protein in the two groups were reduced compared withthose before surgery, and the levels in LVIS/LVIS Jr group were (19.85±1.17) mmHg, (47.36±6.22) μg/L, and (0.72±0.12) μg/mL, which were significantly lower than (22.18±1.95) mmHg, (50.34±5.96) μg/L, and (0.79±0.15) μg/mL in Neuroformgroup (P<0.05). The mRS score, aneurysm recanalization rate, and stent thrombosis rate were (1.97±0.56) points, 2.63%,and 0 in LVIS/LVIS Jr group, which were significantly lower than (2.38±0.61) points, 17.50%, and 10.00% in Neuro-form group (P<0.05). The incidence rates of coil escape, hydrocephalus, parent artery stenosis, and cerebral vasospasmin LVIS/LVIS Jr group were 5.26%, 0, 5.26%, and 2.63%, which were not significantly different from 2.50%, 2.50%,7.50%, and 5.00% in Neuroform group (P>0.05). Conclusion LVIS/LVIS Jr stent is more effective in IA embolizationtreatment, and it can improve the intracranial circulation and neurological function of patients. It has good long-termprognosis and can also reduce the risk of stent thrombosis.
      【Key words】 Intracranial aneurysm; Coil embolization; Neuroform stent; LVIS stent; LVIS Jr stent; Clinical ef-fects; Long-term prognosis