Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
Neurosurgery. 2012 Oct;71(4):785-94. doi: 10.1227/NEU.0b013e318265a416.
Endovascular therapy is now the preferred treatment option for basilar tip aneurysms (BTAs).
To compare the safety and efficacy of common endovascular techniques in the treatment of BTAs.
A retrospective review was conducted of 235 patients with BTAs treated with endovascular means in our institution between 2004 and 2011. Categorization was based on the presence and type of stent assistance (none, single, and Y stenting). The rates of perioperative complications, recanalization, rehemorrhage, and retreatment were analyzed.
A total of 147 patients were treated with coil embolization and 88 patients with stent-assisted coiling (72 single stents, 16 Y stents). Thromboembolic complications occurred in 6.8% of patients in both groups. There was no associated mortality. Angiographic follow-up (mean, 23.5 months) was available in 172 patients (77.1%). Stented patients had significantly lower recanalization (17.2% vs 38.9%; P=.003) and retreatment (7.8% vs 27.8%; P=.002) rates compared with nonstented patients. Four rehemorrhages (2.7%) occurred in the coiled group, whereas none were noted in the stented group (P=.3). In paired comparisons, lower recanalization (8.3% vs 19.2%; P=.21) and retreatment (0% vs 9.6%; P=.19) rates were seen in the Y-stent group compared with the single-stent group. Thromboembolic complications occurred in 6.9% and 6.2% of patients in the single-stent and Y-stent groups, respectively (P=.91). In multivariate analysis, larger aneurysms, nonstented aneurysms, incomplete initial occlusion, and subarachnoid hemorrhage were predictors of aneurysm recanalization.
Stent-assisted coiling has significantly lower recurrence, retreatment, and rehemorrhage rates than coiling alone for the treatment of BTAs. Y stenting has the highest efficacy with low complication rates.
血管内治疗现已成为基底尖动脉瘤（BTAs）的首选治疗方法。
比较常见的血管内技术在治疗 BTAs 中的安全性和有效性。
对 2004 年至 2011 年间在我院接受血管内治疗的 235 例 BTAs 患者进行回顾性分析。分类基于支架辅助的存在和类型（无、单支架和 Y 型支架）。分析围手术期并发症、再通率、再出血率和再治疗率。
共 147 例患者接受了线圈栓塞治疗，88 例患者接受了支架辅助线圈栓塞治疗（72 例单支架，16 例 Y 型支架）。两组患者的血栓栓塞并发症发生率均为 6.8%。无相关死亡率。172 例患者（77.1%）可进行血管造影随访（平均 23.5 个月）。支架组患者的再通率（17.2%比 38.9%；P=.003）和再治疗率（7.8%比 27.8%；P=.002）明显低于非支架组患者。线圈组发生 4 例再出血（2.7%），支架组无再出血（P=.3）。配对比较显示，Y 型支架组与单支架组相比，再通率（8.3%比 19.2%；P=.21）和再治疗率（0%比 9.6%；P=.19）较低。单支架组和 Y 型支架组患者的血栓栓塞并发症发生率分别为 6.9%和 6.2%（P=.91）。多因素分析显示，较大的动脉瘤、非支架动脉瘤、不完全初始闭塞和蛛网膜下腔出血是动脉瘤再通的预测因素。
支架辅助线圈栓塞治疗 BTAs 的复发、再治疗和再出血率明显低于单纯线圈栓塞。Y 型支架的疗效最高，并发症发生率低。
