【摘要】 目的 探讨pipeline栓塞装置（PED）治疗大脑中动脉（MCA）动脉瘤的临床效果。方法 回顾性分析2014年11月至2019年10月我国14个临床中心采用PED治疗的33例MCA动脉瘤的临床资料、影像学资料和随访资料。结果 33例共39个动脉瘤，使用37个PED。33例完成临床随访，30例（36个动脉瘤）完成影像随访；随访时间4～22个月，平均（10.6±6.3）个月；动脉瘤完全或近全闭塞30个（83.3%,30/36）；相对于单纯PED治疗组（71.4%）,PED辅助弹簧圈栓塞组动脉瘤闭塞率更高（100%;P=0.031）；预后不良（m RS评分>2分）3例（9.1%），预后良好（mRS评分≤2分）30例（90.9%）；术后并发症发生率为24.2%(8/33)，术前规律服用双抗药物3 d以上病人术后并发症发生率明显低于未规律服用双抗药物的病人（P=0.033）。结论 MCA动脉瘤可以采用PED治疗，疗效较满意。对于直径大、形态不规则的MCA动脉瘤，可使用PED结合弹簧圈栓塞治疗以获得更高的闭塞率。术前、术后应规范应用双抗药物以减少缺血、出血并发症。更多还原

【Abstract】 Objective To investigate the clinical efficacy of pipeline embolization devices(PED) for patients with middle cerebral artery(MCA) aneurysms. Methods The clinical data, imaging data and follow-up data of 33 patients with MCA aneurysms treated with PED in 14 clinical centers from November 2014 to October 2019 were retrospectively analyzed. Results Thirty-seven PEDs were used in 33 patients with 39 MCA aneurysms. Clinical follow-up was completed in 33 patients and imaging follow-up was completed in 30patients(36 aneurysms). The follow-up time ranged from 4 to 22 months, with an average of(10.6 ± 6.3) months. Complete or near complete occlusion of aneurysms were achieved in 30 aneurysms(83.3%, 30/36). Compared with the patients treated with PED alone[71.4%(15/21)], the occlusion rate of aneurysms was significantly higher in the patients treated with PED-assisted coil embolization[100%(15/15); P=0.031]. Thirty patients(90.9%) had good prognoses(mRS score ≤2), and 3(9.1%) had poor prognoses(mRS score >2).The incidence of postoperative complications was 24.2%(8/33), and patients who received dual antiplatelet therapy for more than 3 days before surgery had a significantly lower incidence of postoperative complications(3.4%) compared to those who did not(50%; P=0.033).Conclusions MCA aneurysms can be treated with PED and the effectiveness is good. For MCA aneurysms with large diameter and irregular morphology, PED combined with coil embolization can obtain a higher occlusion rate. Preoperative and postoperative dual antiplatelet therapies are recommended to decrease ischemia and bleeding complications.更多还原