Simon Scott, Archer Kellie, Mericle Robert
Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA.
World Neurosurg. 2014 Dec;82(6):e731-8. doi: 10.1016/j.wneu.2013.03.070. Epub 2013 Mar 30.
The Cerebral Aneurysm Multicenter European Onyx trial was the first multicenter prospective case series using liquid embolization for cerebral aneurysms. It suggested a possible decreased risk for recanalization of smaller aneurysms compared with coil embolization. After publication of that trial, the Onyx HD embolic agent, injection devices, and treatment protocols have all been updated and improved to increase efficacy and decrease adverse events. We present the results from a multicenter registry of liquid embolization treatments using the current method and materials. We hypothesize that the evolution of this technique will result in lower complication and recanalization rates when compared with earlier series.
Surgeons performing liquid embolization submitted data about consecutive patients and procedures. The data provided were used to determine what characteristics were associated with durable occlusion and recanalization.
One hundred thirteen patients at 25 medical centers throughout the United States underwent liquid embolization. Of these, 110 had follow-up data of at least 6 months. Seventeen patients (15%) experienced a complication and 4 (3.5%) experienced procedure-related ischemic stroke or death. Nine patients (8.1%) had aneurysm recanalization and 5 (4.5%) required retreatment. All retreatments were accomplished with further liquid embolization and were stable at the last follow-up angiogram available. Those with durable occlusion had smaller aneurysm size (mean, 10 mm vs. 17 mm) (P = 0.03) and were de novo (P = 0.02).
Recent advances in liquid embolization have led to decreased recanalization and complications. Liquid embolization is more likely to achieve a durable result in smaller aneurysms that have not been previously treated.
欧洲脑动脉瘤多中心Onyx试验是首个使用液体栓塞治疗脑动脉瘤的多中心前瞻性病例系列研究。该研究表明，与弹簧圈栓塞相比，较小动脉瘤再通的风险可能降低。该试验发表后，Onyx HD栓塞剂、注射装置和治疗方案均已更新和改进，以提高疗效并减少不良事件。我们展示了使用当前方法和材料进行液体栓塞治疗的多中心注册研究结果。我们假设，与早期系列研究相比，该技术的发展将导致更低的并发症和再通率。
进行液体栓塞治疗的外科医生提交了关于连续患者和手术的数据。所提供的数据用于确定哪些特征与持久闭塞和再通相关。
美国25个医疗中心的113例患者接受了液体栓塞治疗。其中，110例患者有至少6个月的随访数据。17例患者（15%）出现并发症，4例患者（3.5%）发生与手术相关的缺血性卒中或死亡。9例患者（8.1%）出现动脉瘤再通，5例患者（4.5%）需要再次治疗。所有再次治疗均通过进一步的液体栓塞完成，并且在最后一次可用的随访血管造影时情况稳定。实现持久闭塞的患者动脉瘤尺寸较小（平均10 mm对17 mm）（P = 0.03），且为初发动脉瘤（P = 0.02）。
液体栓塞的最新进展已导致再通率和并发症降低。液体栓塞更有可能在未接受过治疗的较小动脉瘤中取得持久的治疗效果。
