【摘要】 目的 比较颅内椎基底动脉干大动脉瘤(VBLA)患者血管内介入治疗中应用支架辅助栓塞(SAC)和血流导向装置(FD)的效果和安全性。方法 2016年1月—2022年2月河南省人民医院诊治VBLA患者58例，血管内介入治疗中应用SAC者28例为SAC组，应用FD者30例为FD组。比较2组年龄、性别比例、合并症、吸烟史、饮酒史、既往脑梗死史、入院改良Rankin量表(mRS)评分、动脉瘤位置、动脉瘤分型、动脉瘤最大径、瘤颈直径、载瘤动脉直径、分支血管从动脉瘤上发出及动脉瘤破裂比率、手术情况、弹簧圈使用情况、手术时间、术后即刻Raymond分级、术后载瘤动脉狭窄程度、闭塞一侧椎动脉比率、出院时mRS评分、住院期间严重不良事件(SAE)发生率。出院后随访至2023年2月，记录随访期间SAE发生情况，末次随访时mRS评分；影像学随访至2022年8月，比较2组末次随访时Raymond分级、动脉瘤闭塞情况。结果 (1)SAC组动脉瘤破裂比率(50.0%)高于FD组(0)(P<0.05),2组年龄、动脉瘤最大径，瘤颈直径，载瘤动脉直径，合并高血压、糖尿病、冠心病、高脂血症比率，有吸烟史、饮酒史、既往脑梗死史比率，女性、分支血管从动脉瘤上发出比率及动脉瘤位置、动脉瘤分型比较差异均无统计学意义(P>0.05)。(2)2组手术均成功，均未应用球囊辅助扩张，术后即刻Raymond分级均为Ⅰ级。FD组出院时mRS评分0～2分比率(100.0%)高于SAC组(75.0%)(χ~2=6.336,P=0.012),手术时间、术后即刻载瘤动脉无狭窄及闭塞一侧椎动脉比率与SAC组比较差异均无统计学意义(P>0.05)。(3)SAC组住院期间发生SAE 5例(出血事件2例，缺血事件3例),FD组未发生SAE,SAC组住院期间SAE发生率(17.9%)与FD组(0)比较差异无统计学意义(χ~2=3.815,P=0.051)。(4)2组随访期间SAE发生率、末次随访时mRS评分比较差异均无统计学意义(P>0.05)。FD组影像学随访失访9例，SAC组失访11例，末次随访时2组动脉瘤均未复发，动脉瘤体积未增大，均未见支架内狭窄或支架内血栓形成，SAC组动脉瘤完全闭塞率、Raymondy分级与FD组比较差异均无统计学意义(P>0.05)。结论 VBLA患者血管内介入治疗中应用SAC和FD均有较好效果，安全性高。更多还原

【Abstract】 Objective To compare the efficacy and safety of stent-assisted coiling(SAC) and flow diverter(FD) in the intravascular interventional treatment of intracranial vertebrobasilar artery large aneurysm(VBLA).Methods From January 2016 to February 2022,58 patients with VBLA were diagnosed and treated in Henan Provincial People’s Hospital,and were divided into SAC group(n=28) and FD group(n=30).The age,gender ratio,comorbidities,smoking history,history of alcohol consumption,previous history of cerebral infarction,modified Rankin scale(mRS)score on admission,aneurysm location,aneurysm type,maximum aneurysm diameter,tumor neck diameter,tumor carrier artery diameter,rate of branch vessels originating from aneurysm,incidence of aneurysm rupture,operation procedure,coil usage,operation lasting time,Raymond grade immediately after operation,postoperative stenosis degree of tumor carrier artery,rate of occlusive vertebral artery,mRS score at discharge,and incidence of intraoperative serious adverse events(SAE) were compared between two groups.The clinical follow-up was done till February 2023 to record SAE, and mRS score was evaluated at the latest follow-up.The imaging follow-up was done till August 2022,and the Raymond grade and aneurysm occlusion were compared between two groups at the latest follow-up.Results(1) The rate of ruptured aneurysm was higher in SAC group(50.0%) than that in FD group(0)(P<0.05),and there were no significant differences in the age,maximum aneurysm diameter,tumor neck diameter,tumor carrier artery diameter,percentages of patients with hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking history,alcohol consumption history and previous cerebral infarction history,female ratio,rate of branch vessels originating from aneurysm,aneurysm location and aneurysm type between two groups(P>0.05).(2) The operation was successful in both groups without balloon assisted dilation,and Raymond grade immediately after operation was grade Ⅰ.The percentage of mRS score 0-2 at discharge was higher in FD group(100.0%) than that in SAC group(75.0%)(χ~2=6.336,P=0.012),and there were no significant differences in the operation lasting time,and the rates of no stenosis immediately after operation of tumor carrier artery and vertebral artery occlusion between two groups(P>0.05).(3) During hospital stay,SAE occurred in 5 patients(hemorrhagic events in 2 and ischemic events in 3) in SAC group,and no SAE occurred in FD group.There was no significant difference in the incidence of SAE between SAC group(17.9%) and FD group(0)(χ~2=3.815,P=0.051).(4) The clinical follow-up showed no significant differences in the incidence of SAE and mRS score at the latest follow-up between two groups(P>0.05).In imaging follow-up,9 patients were lost in FD group and 11 were lost in SAC group;the latest follow-up showed no aneurysm recurrence,no increase in aneurysm volume,no intrastent stenosis,and no intrastent thrombosis in two groups;there were no significant differences in the rate of complete aneurysm occlusion and Raymond grade between two groups(P>0.05).Conclusion Both SAC and FD are effective and safe for intracranial VBLA.更多还原