Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
J Clin Neurosci. 2013 Apr;20(4):527-31. doi: 10.1016/j.jocn.2012.01.058. Epub 2013 Jan 13.
Initial incomplete occlusion is been an important predictor of aneurysm recurrence, rebleeding or retreatment after endovascular coiling. In 129 patients in the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, ruptured aneurysms were coiled within 14days of onset, and initial post-coiling and 1-year follow-up aneurysm-occlusion status were evaluated by both local investigators and independent reviewers. The aim of this study was to investigate whether self-reported evaluations of initial aneurysm occlusion by treating physicians predicted incomplete aneurysm occlusion at 1year after coiling for ruptured cerebral aneurysms as well as that done by independent evaluations. The relationships between self-reported or independent evaluations of initial anatomic results and 1-year incomplete aneurysm occlusion (retreatment within 1year, or residual aneurysms at 1year) were determined. Both initial and 1-year aneurysm-occlusion status were judged significantly worse by independent reviewers than by local investigators (p<0.001). One-year incomplete aneurysm occlusion was identified in 59 patients: 10 patients, including two patients with re-ruptured aneurysms, were retreated and 49 other patients were judged to have residual aneurysms by independent reviewers. On immediate post-coiling angiograms, both residual neck or aneurysm judged by local investigators, and residual aneurysm judged by independent reviewers, were predictive for 1-year incomplete aneurysm occlusion on univariate analyses. However, multivariate analyses found that the initial aneurysm occlusion status judged by independent reviewers (p=0.02, odds ratio=2.83, 95% confidence interval=1.15-6.95), but not by local investigators, was a significant predictor for 1-year incomplete aneurysm occlusion. This study demonstrates the importance of independent evaluations of aneurysm occlusion status for management of coiled aneurysms.
初始不完全闭塞是动脉瘤复发、再出血或血管内治疗后再治疗的重要预测因素。在 Prospective Registry of Subarachnoid Aneurysms Treatment（PRESAT）队列的 129 名患者中，破裂的动脉瘤在发病后 14 天内进行了血管内治疗，并且通过当地研究人员和独立审查员评估了初始血管内治疗后和 1 年随访时的动脉瘤闭塞状态。本研究旨在调查治疗医生对初始动脉瘤闭塞的自我评估是否可以预测破裂性脑动脉瘤血管内治疗后 1 年的不完全动脉瘤闭塞，以及独立评估的情况。确定了自我报告或独立评估的初始解剖学结果与 1 年内不完全性动脉瘤闭塞（1 年内再次治疗或 1 年内残余动脉瘤）之间的关系。独立审查员判断的初始和 1 年动脉瘤闭塞状态均明显差于当地研究人员（p<0.001）。59 名患者诊断为 1 年内不完全性动脉瘤闭塞：10 名患者，包括 2 名动脉瘤再破裂的患者，进行了再治疗，49 名其他患者被独立审查员判断为残余动脉瘤。在血管内治疗后立即的血管造影中，当地研究人员判断的残余瘤颈或动脉瘤和独立审查员判断的残余动脉瘤，在单变量分析中均预测 1 年内不完全性动脉瘤闭塞。然而，多变量分析发现，独立审查员判断的初始动脉瘤闭塞状态（p=0.02，优势比=2.83，95%置信区间=1.15-6.95），而不是由当地研究人员判断的，是 1 年内不完全性动脉瘤闭塞的重要预测因素。本研究表明，独立评估动脉瘤闭塞状态对血管内治疗动脉瘤的管理非常重要。
