Frontera Jennifer A, Moatti Joseph, de los Reyes Kenneth M, McCullough Stephen, Moyle Henry, Bederson Joshua B, Patel Aman
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
J Neurointerv Surg. 2014 Jan;6(1):65-71. doi: 10.1136/neurintsurg-2012-010544. Epub 2012 Dec 7.
Stent-assisted coiling (SAC) of unruptured intracranial aneurysms is a treatment alternative to clipping or coiling, although high complication and procedure-related mortality rates have been reported.
A retrospective study was conducted of patients undergoing SAC, coiling or clipping of unruptured intracranial aneurysms between 2003 and 2010. Rates of residual aneurysm, recanalization, complications, cost (adjusted to 2010), length of stay (LOS) and outcome were compared between groups.
Of 116 subjects, 47 underwent SAC, 33 coiling and 36 clipping. The groups were similar in age, gender and aneurysm location, although the SAC group had significantly larger aneurysms with wider necks (p=0.001). Patients who underwent SAC had more residual aneurysm after initial treatment than those treated with coiling or clipping (75%, 52% and 19%, respectively, p<0.0001), but this difference was smaller at follow-up angiography (50%, 50% and 17% residual, respectively) and was not significant after adjusting for baseline aneurysm and neck size. SAC was not associated with increased recanalization, requirement for additional treatment, mortality or complications after adjusting for aneurysm and neck size. Patients who underwent SAC and those who underwent coiling were more likely to have a good discharge disposition than patients treated with clipping (100% vs 91%, p=0.042). LOS was significantly shorter for patients who underwent SAC or coiling compared with those treated with clipping (p<0.0001). The overall direct cost was higher for patients who underwent SAC than for those treated with coiling or clipping (median $22 544 vs $12 933 vs $14 656, p=0.001), even after adjusting for aneurysm and neck size, LOS and retreatment.
SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.
未破裂颅内动脉瘤的支架辅助弹簧圈栓塞术（SAC）是一种替代夹闭术或单纯弹簧圈栓塞术的治疗方法，尽管已有报道称其并发症和手术相关死亡率较高。
对2003年至2010年间接受SAC、单纯弹簧圈栓塞术或夹闭术治疗未破裂颅内动脉瘤的患者进行回顾性研究。比较各组之间的残余动脉瘤发生率、再通率、并发症、费用（调整至2010年）、住院时间（LOS）及预后情况。
116例患者中，47例行SAC，33例行单纯弹簧圈栓塞术，36例行夹闭术。各组患者在年龄、性别及动脉瘤位置方面相似，尽管SAC组的动脉瘤明显更大且瘤颈更宽（p = 0.001）。接受SAC治疗的患者在初始治疗后残余动脉瘤的比例高于单纯弹簧圈栓塞术或夹闭术治疗的患者（分别为75%、52%和19%，p < 0.0001），但在随访血管造影时这种差异较小（残余比例分别为50%、50%和17%），在对基线动脉瘤和瘤颈大小进行校正后差异无统计学意义。在对动脉瘤和瘤颈大小进行校正后，SAC与再通增加、额外治疗需求、死亡率或并发症无关。与接受夹闭术的患者相比，接受SAC和单纯弹簧圈栓塞术的患者出院时预后良好的可能性更大（100%对91%，p = 0.042）。与接受夹闭术的患者相比，接受SAC或单纯弹簧圈栓塞术的患者住院时间明显更短（p < 0.0001）。即使在对动脉瘤和瘤颈大小、住院时间及再次治疗进行校正后，接受SAC治疗的患者的总体直接费用仍高于接受单纯弹簧圈栓塞术或夹闭术的患者（中位数分别为22544美元对12933美元对14656美元，p = 0.001）。
SAC是未破裂动脉瘤单纯弹簧圈栓塞术或夹闭术的一种安全替代方法，但目前费用更高。
