破裂性基底动脉尖动脉瘤患者的血管内栓塞术与神经外科夹闭术对比
Endovascular coiling versus neurosurgical clipping in patients with a ruptured basilar tip aneurysm.
作者信息
Lusseveld E, Brilstra E H, Nijssen P C G, van Rooij W J J, Sluzewski M, Tulleken C A F, Wijnalda D, Schellens R L L A, van der Graaf Y, Rinkel G J E
机构信息
Department of Neurology, St Elisabeth Hospital, Tilburg, Netherlands.
出版信息
J Neurol Neurosurg Psychiatry. 2002 Nov;73(5):591-3. doi: 10.1136/jnnp.73.5.591.
OBJECTIVES
To compare endovascular coiling with neurosurgical clipping of ruptured basilar bifurcation aneurysms.
METHODS
Patient and aneurysm characteristics, procedural complications, and clinical and anatomical results were compared retrospectively in 44 coiled patients and 44 patients treated by clipping. The odds ratios for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for age, clinical condition, and aneurysm size were assessed by logistic regression analysis.
RESULTS
In the endovascular group, five patients (11%) had a poor outcome v 13 (30%) in the surgical group; the adjusted odds ratio for poor outcome after coiling v clipping was 0.28 (95% confidence interval, 0.08 to 0.99). Procedural complications were more common in the surgical group. Optimal or suboptimal occlusion of the aneurysm immediately after coiling was achieved in 41 patients (93%). Clipping was successful in 40 patients (91%).
CONCLUSIONS
The results suggest that embolisation with coils is the preferred treatment for patients with ruptured basilar bifurcation aneurysms.
目的
比较破裂性基底动脉分叉部动脉瘤的血管内栓塞术与神经外科夹闭术。
方法
对44例行栓塞术患者和44例行夹闭术患者的患者及动脉瘤特征、手术并发症以及临床和解剖学结果进行回顾性比较。通过逻辑回归分析评估根据年龄、临床状况和动脉瘤大小调整后的不良预后（格拉斯哥预后量表1、2、3级）比值比。
结果
血管内治疗组有5例患者（11%）预后不良，而手术组有13例（30%）；栓塞术与夹闭术后不良预后的调整后比值比为0.28（95%置信区间，0.08至0.99）。手术组的手术并发症更为常见。41例患者（93%）在栓塞术后立即实现了动脉瘤的最佳或次优闭塞。40例患者（91%）夹闭成功。
结论
结果表明，对于破裂性基底动脉分叉部动脉瘤患者，弹簧圈栓塞术是首选治疗方法。
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