血管内治疗无症状未破裂颅内动脉瘤：JR-NET 和 JR-NET2 研究结果。
Endovascular therapy for asymptomatic unruptured intracranial aneurysms: JR-NET and JR-NET2 findings.
机构信息
From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.).
出版信息
Stroke. 2013 Oct;44(10):2735-42. doi: 10.1161/STROKEAHA.111.000609. Epub 2013 Jul 30.
BACKGROUND AND PURPOSE
National registration studies (the Japanese Registry of Neuroendovascular Therapy [JR-NET] and JR-NET2) have determined the current status and outcomes of neuroendovascular therapy (neuro-EVT). We analyzed short-term outcomes of EVT for asymptomatic unruptured intracranial aneurysms (UIAs).
METHODS
We extracted periprocedural information about EVT for 4767 asymptomatic UIAs from 31,968 registered procedural records of all EVT in the JR-NET and JR-NET2 databases. We assessed the features of the aneurysms and procedures, immediate radiographic findings, procedure-related complications, and clinical outcomes at 30 days after the procedures.
RESULTS
We located 80.0% of UIAs in the anterior circulation, and the most frequent were paraclinoid. The diameter of 2.5%, 32.9%, 51.9%, 12.0%, and 0.7% of the UIAs was <3, 3 to 4, 5 to 9, 10 to 19, and >20 mm, respectively. EVT failed in only 2.1%. Adjunctive techniques were applied in 54.8% of procedures. Pre- and postprocedural antiplatelet agents were prescribed in 85.6% and 84.0%, respectively, of the procedures. The immediate radiographic outcomes of 57.7%, 31.9%, and 10.0% of the UIAs comprised complete occlusion, residual necks, and residual aneurysms, respectively. Complications that were associated with 9.1% of procedures comprised 2.0% hemorrhagic and 4.6% ischemic, and the 30-day morbidity and mortality rates were 2.12% and 0.31%, respectively.
CONCLUSIONS
The radiographic results of EVT for asymptomatic UIAs in Japan were acceptable, with low mortality and morbidity rates.
背景与目的
国家注册研究（日本神经血管治疗注册研究[JR-NET]和 JR-NET2）已经确定了神经血管治疗（神经-EVT）的现状和结果。我们分析了 EVT 治疗无症状未破裂颅内动脉瘤（UIAs）的短期结果。
方法
我们从 JR-NET 和 JR-NET2 数据库中所有 EVT 的 31968 份注册手术记录中提取了 4767 例无症状 UIAs 的围手术期信息。我们评估了动脉瘤和手术的特征、即刻影像学发现、与手术相关的并发症以及手术后 30 天的临床结果。
结果
我们定位了 80.0%的 UIAs 在前循环中，最常见的是颈内动脉海绵窦段。2.5%、32.9%、51.9%、12.0%和 0.7%的 UIAs 的直径分别为<3、3 至 4、5 至 9、10 至 19 和>20mm。EVT 仅失败 2.1%。54.8%的手术中应用了辅助技术。85.6%和 84.0%的手术分别给予了术前和术后抗血小板药物。57.7%、31.9%和 10.0%的 UIAs 的即刻影像学结果分别为完全闭塞、残留瘤颈和残留动脉瘤。与 9.1%的手术相关的并发症包括 2.0%的出血性和 4.6%的缺血性，30 天发病率和死亡率分别为 2.12%和 0.31%。
结论
日本 EVT 治疗无症状 UIAs 的影像学结果可接受，死亡率和发病率较低。
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