联合使用线圈与管道栓塞装置治疗颅内动脉瘤。

Use of coils in conjunction with the pipeline embolization device for treatment of intracranial aneurysms.

作者信息

Lin Ning, Brouillard Adam M, Krishna Chandan, Mokin Maxim, Natarajan Sabareesh K, Sonig Ashish, Snyder Kenneth V, Levy Elad I, Siddiqui Adnan H

机构信息

*Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‡Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York; §Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ¶Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; ‖Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; #Jacobs Institute, Buffalo, New York.

出版信息

Neurosurgery. 2015 Feb;76(2):142-9. doi: 10.1227/NEU.0000000000000579.

DOI:10.1227/NEU.0000000000000579

PMID:25255261

Abstract

BACKGROUND

Coiling in conjunction with Pipeline embolization device (PED) placement could provide immediate dome protection and an intraaneurysmal scaffold to prevent device prolapse for intracranial aneurysms with high rupture risk and complex anatomy.

OBJECTIVE

To report results after treatment of aneurysms with PED with coils (PED+coils group) or without (PED-only group) at a single-institution.

METHODS

In this case-controlled study, records of patients who underwent PED treatment between 2011 and 2013 were retrospectively reviewed.

RESULTS

Twenty-nine patients were treated with PED+coils and 75 with PED-only. No statistically significant between-group differences were found in terms of age, sex, aneurysm location, medical comorbidities, and length of follow-up. Aneurysms treated by PED+coils were larger (16.3 mm vs 12.4 mm, P=.02) and more likely to be ruptured (20.7% vs 1.3%, P=.001) or dissecting (34.5% vs 9.3%, P=.002). PED deployment was successful in all cases. At the latest follow-up (mean, 7.8 months), complete aneurysm occlusion was achieved in a higher proportion of the PED+coils group (93.1% vs 74.7%, P=.03). Device foreshortening/migration occurred in 4 patients in the PED-only group and none in the PED+coils group. Fewer patients required retreatment in the PED+coils group (3.4% vs 16.0%, P=.71). Rates of neurological complications (10.3% PED+coils vs 8.0% PED-only, P=.7) and favorable outcome (modified Rankin Scale score=0-2; 93.1% PED+coils vs 94.7% PED-only, P=.6) were similar.

CONCLUSION

PED+coils may be a safe and effective treatment for aneurysms with high risk of rupture (or rerupture) and complex anatomy. Coiling in conjunction with PED placement provided a higher aneurysm occlusion rate and reduced the need for retreatment.

摘要

背景

联合使用弹簧圈与管道栓塞装置（PED）置入可为破裂风险高且解剖结构复杂的颅内动脉瘤提供即时的瘤顶保护和瘤内支架，以防止装置脱垂。

目的

报告在单一机构中，使用PED联合弹簧圈（PED+弹簧圈组）或不联合弹簧圈（单纯PED组）治疗动脉瘤后的结果。

方法

在这项病例对照研究中，回顾性分析了2011年至2013年间接受PED治疗的患者记录。

结果

29例患者接受了PED+弹簧圈治疗，75例接受了单纯PED治疗。在年龄、性别、动脉瘤位置、合并症和随访时间方面，两组之间未发现统计学上的显著差异。接受PED+弹簧圈治疗的动脉瘤更大（16.3毫米对12.4毫米，P=0.02），更可能破裂（20.7%对1.3%，P=0.001）或夹层（34.5%对9.3%，P=0.002）。所有病例中PED置入均成功。在最近一次随访（平均7.8个月）时，PED+弹簧圈组实现完全动脉瘤闭塞的比例更高（93.1%对74.7%，P=0.03）。单纯PED组有4例患者发生装置缩短/移位，而PED+弹簧圈组无此情况。PED+弹簧圈组需要再次治疗的患者较少（3.4%对16.0%，P=0.71）。神经并发症发生率（PED+弹簧圈组为10.3%，单纯PED组为8.0%，P=0.7）和良好预后率（改良Rankin量表评分为0-2；PED+弹簧圈组为93.1%，单纯PED组为94.7%，P=0.6）相似。