39例Surpass Streamline治疗未破裂动脉瘤患者诊疗分析：单中心临床经验

doi:10.3877/cma.j.issn.2095-5782.2023.01.004

目的

探讨单中心血流导向装置Surpass Streamline治疗未破裂动脉瘤的有效性和安全性。

方法

回顾性分析2020年12月至2022年8月珠海市人民医院脑血管病诊疗中心采用Surpass Streamline治疗39例未破裂动脉瘤患者的临床资料。39例患者共45个动脉瘤，其中位于眼段23个、交通段6个、海绵窦段5个、床突段4个、V4段4个、岩段2个、颈段1个。

结果

39例患者植入39枚Surpass Streamline，支架释放成功率100%，38例（97.4%）释放效果满意，1例因贴壁不良需桥接支架，38个动脉瘤于术后（3.8 ± 1.4）个月内进行首次随访，OKM分级D级30个（78.9%）、C级7个（18.4%）、B级1个（2.7%），可见6例（18.8%）支架再狭窄（4例轻度，2例中度），但均无明显血流受限。15例患者共16个动脉瘤于术后（12.1 ± 2.3）个月随访，OKM分级D级15个（93.8%），其中2例首次随访再狭窄（1例轻度，1例中度）患者于术后1年复查时，原狭窄基本完全恢复，管腔显示良好。

结论

Surpass Streamline治疗未破裂动脉瘤的安全性及有效性良好，支架再狭窄一般不影响血流及动脉瘤的愈合，且有一定的自限性，短期及中期随访较满意，仍有待进一步大样本、多中心、长期的随访研究验证。

关键词: 未破裂动脉瘤, 血管内治疗, Surpass Streamline, 血流导向装置, 支架再狭窄

Objective

To investigate the efficacy and safety of the single center flow diverter Surpass Streamline in the treatment of unruptured aneurysms.

Methods

The clinical data of 39 patients with unruptured aneurysms treated with Surpass Streamline from December 2020 to August 2022 in the cerebrovascular disease diagnosis and treatment center of Zhuhai People's Hospital were analyzed retrospectively. There were 45 aneurysms in 39 patients, including 23 in the ocular segment, 6 in the traffic segment, 5 in the cavernous sinus segment, 4 in the clinoid process segment, 4 in the V4 segment, 2 in the petrous segment, and 1 in the cervical segment.

Results

39 patients were implanted with 39 Surpass Streamlines, the success rate of stent release was 100%, 38 patients (97.4%) were satisfied with the release effect, 1 patient bridged the stent due to poor adhesion, 38 aneurysms were followed up for the first time within 3.8 ± 1.4 months after operation, 30 patients (78.9%) in OKM grade D, 7 patients (18.4%) in grade C,and 1 patient (2.7%) in grade B, 6 patients (18.8%) had stent restenosis (4 patients were mild, 2 patients were moderate), but there was no obvious blood flow restriction. A total of 16 aneurysms in 15 patients were followed up 12.1 ± 2.3 months after operation, and 15 (93.8%) were of OKM grade D. Among them,2 patients with restenosis (1 mild, 1 moderate) were followed up for the first time, and the original stenosis was basically completely recovered and the lumen was well displayed after 1 year of follow-up.

Conclusions

Surpass Streamline is safe and effective in the treatment of unruptured aneurysms. Stent restenosis generally does not affect the blood flow and the healing of aneurysms, and has a certain degree of self-limiting. The short-term and medium-term follow-up is satisfactory, and still needs to be verified by further large sample, multi-center and long-term follow-up research.

Key words: Unruptured aneurysm, Endovascular therapy, Surpass Streamline, Flow diverter, Stent restenosis

图1 采用Surapss Streamline血流导向装置治疗左侧颈内动脉瘤的影像学资料1A：术前DSA三维重组图像，示左侧颈内动脉大型动脉瘤，瘤颈×高度×宽度（6.1 × 8.3× 11.4 mm）；1B、1C：植入Surpass Streamline后的稀释造影，可见贴壁良好；1D：术后4个月复查DSA，可见动脉瘤已完全愈合，OKM分级D级；1E：术后4个月DSA三维重组图像，支架在位、通畅，近端及远端均未见明显狭窄。

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Diagnosis and treatment of 39 patients with unruptured aneurysm treated with Surpass Streamline: single center clinical experience

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Diagnosis and treatment of 39 patients with unruptured aneurysm treated with Surpass Streamline: single center clinical experience