Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, 710 W 168th Street, New York, NY 10032, USA.
Stroke. 2011 Oct;42(10):2844-9. doi: 10.1161/STROKEAHA.111.619767. Epub 2011 Aug 18.
Unruptured intracranial aneurysms (UIAs) are being identified more frequently and endovascular coil embolization has become an increasingly popular treatment modality. Our study evaluates patient outcomes with changing patterns of treatment of UIA.
We conducted a retrospective, longitudinal cohort study of 3132 hospital discharges for UIA identified from the New York Statewide Database (SPARCS) in 2005 to 2007 and 2200 discharges from 1995 to 2000. The rates of endovascular coiling and surgical clipping were examined along with hospital variables and discharge outcome. Anatomic specifics of UIA were unavailable for analysis.
The case rate for treatment of UIA doubled from 1.59 (1995 to 2000) to 3.45 per 100,000 (2005 to 2007, P<0.0001) and increased in the case treatment rate for coiling of UIA (0.36 versus 1.98 per 100,000, P<0.0001). Compared with the old epoch, there were more UIAs clipped at high-volume centers (55.8% versus 78.8%, P<0.0001) but fewer coiled at high-volume centers (94.8% versus 84.5%, P<0.0001) in the new epoch. Coiling and increasing hospital UIA treatment volume were associated with good discharge outcome. However, there was no significant improvement in overall good outcome when comparing 1995 to 2000 versus 2005 to 2007 (79% versus 81%, P=0.168) and a worsening of good outcomes for clipping (76.3% versus 71.7%, P=0.0132).
Despite coiling being associated with an increased incidence of good outcome relative to clipping of UIA, the increase in coiling has failed to improve overall patient outcome. The shift in coiling venue from high-volume centers to low-volume centers and decreasing microsurgical volume accompanied by a worsening in microsurgical results contribute to this. This argues for greater centralization of care.
未破裂颅内动脉瘤（UIAs）的检出率越来越高，血管内线圈栓塞已成为一种越来越受欢迎的治疗方法。我们的研究评估了随着 UIAs 治疗模式的变化，患者的治疗结果。
我们对 2005 年至 2007 年期间从纽约州全州数据库（SPARCS）中确定的 3132 例 UIAs 医院出院患者和 1995 年至 2000 年期间的 2200 例出院患者进行了回顾性、纵向队列研究。检查了血管内线圈栓塞和手术夹闭的比率以及医院变量和出院结果。UIA 的解剖学细节无法进行分析。
UIA 治疗的病例发生率从 1.59（1995 年至 2000 年）增加到 3.45/100000（2005 年至 2007 年，P<0.0001），UIA 血管内线圈栓塞的病例治疗率也增加（0.36 比 1.98/100000，P<0.0001）。与旧时代相比，新时代夹闭 UIAs 的高容量中心数量更多（55.8%比 78.8%，P<0.0001），但高容量中心的线圈栓塞数量更少（94.8%比 84.5%，P<0.0001）。线圈栓塞和增加医院 UIA 治疗量与良好的出院结果相关。然而，将 1995 年至 2000 年与 2005 年至 2007 年相比，整体良好结局并没有显著改善（79%比 81%，P=0.168），夹闭的良好结局也有所恶化（76.3%比 71.7%，P=0.0132）。
尽管与夹闭 UIA 相比，线圈栓塞与良好的结局相关，但线圈栓塞的增加并未改善患者的整体预后。这种情况的发生是由于线圈栓塞治疗场所从高容量中心向低容量中心转移，以及显微手术量减少，同时显微手术结果恶化。这就需要对治疗进行更集中的管理。
