Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Neurointerv Surg. 2013 Jul;5(4):317-20. doi: 10.1136/neurintsurg-2012-010349. Epub 2012 May 5.
Adjunctive stenting has increasingly become an acceptable option for the endovascular treatment of unruptured aneurysms. The Nationwide Inpatient Sample (NIS) was used to compare US in-hospital outcomes related to coiling with and without adjunctive stenting for unruptured aneurysms.
Hospitalizations for coiling of unruptured cerebral aneurysms from 2004 to 2008 were identified in the NIS by extracting ICD-9-CM codes for the diagnosis of unruptured aneurysm (437.3) and intracranial stenting (00.65) with coiling (39.52, 39.79 or 39.72) of cerebral aneurysms. All patients with a diagnosis of subarachnoid hemorrhage (430) and/or intracerebral hemorrhage (431) were excluded. Mortality and discharge to a long-term facility were compared between stent and non-stent patient groups using multivariate regression analysis.
Patients treated with stent-assisted coiling had an in-hospital mortality rate of 0.08-0.8% compared with a death rate of 0.5% (95% CI 0.3% to 0.7%) for patients who did not receive a stent during coiling (p=0.36). Patients in the stent group had a 3% rate of discharge to a care facility (95% CI 1.5% to 5.8%) compared with 5% (95% CI 4.5% to 5.6%) for those in the non-stent group (p=0.14). Patients treated with a stent had a similar likelihood of in-hospital mortality (adjusted OR, 2.12 (95% CI 0.32 to 7.11), p=0.34) and a lower likelihood of discharge to a long-term care facility (adjusted OR 0.59 (95% CI 0.24 to 1.16), p=0.16) compared with the non-stent group.
Adjunctive stenting adds little in-hospital risk to the endovascular treatment of cerebral aneurysms. However, the need for dual antiplatelet therapy may predispose to delayed hemorrhagic complications and discontinuation of dual antiplatelet therapy may lead to delayed thromboembolic complications.
辅助支架置入术已逐渐成为治疗未破裂动脉瘤的一种可接受的选择。本研究使用全国住院患者样本（NIS）比较了血管内治疗未破裂动脉瘤时使用和不使用辅助支架的住院期间相关结局。
通过提取 NIS 中未破裂颅内动脉瘤（ICD-9-CM 编码 437.3）和颅内支架置入术（ICD-9-CM 编码 00.65）的诊断代码（同时存在颅内支架置入术、血管内治疗未破裂动脉瘤代码 39.52、39.79 或 39.72），确定 2004 年至 2008 年期间进行的血管内治疗未破裂颅内动脉瘤的住院病例。排除蛛网膜下腔出血（430）和/或脑内出血（431）的诊断病例。采用多变量回归分析比较支架组和非支架组患者的死亡率和出院至长期护理机构的情况。
支架辅助弹簧圈治疗患者的住院死亡率为 0.08%0.8%，而未接受支架治疗的患者死亡率为 0.5%（95%CI 0.3%0.7%）（p=0.36）。支架组患者出院至护理机构的比例为 3%（95%CI 1.5%5.8%），而非支架组患者为 5%（95%CI 4.5%5.6%）（p=0.14）。支架治疗组患者的院内死亡率相似（校正比值比，2.12（95%CI 0.327.11），p=0.34），而长期护理机构出院率较低（校正比值比，0.59（95%CI 0.241.16），p=0.16）。
辅助支架置入术对颅内动脉瘤的血管内治疗几乎没有增加院内风险。然而，双重抗血小板治疗的需求可能会导致迟发性出血性并发症，而双重抗血小板治疗的停药可能会导致迟发性血栓栓塞性并发症。
