Consoli Arturo, Vignoli Chiara, Renieri Leonardo, Rosi Andrea, Chiarotti Ivano, Nappini Sergio, Limbucci Nicola, Mangiafico Salvatore
Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
Department of Radiology, Careggi University Hospital, Florence, Italy.
J Neurointerv Surg. 2016 Jan;8(1):52-7. doi: 10.1136/neurintsurg-2014-011466. Epub 2014 Nov 26.
Assisted coiling with stents or balloons enables a higher percentage of complete occlusions of saccular unruptured intracranial aneurysms to be achieved with a reasonable complication rate. The aim of this study was to compare stent-assisted coiling and the balloon remodeling technique in terms of efficacy, stability, and safety for the treatment of comparable unruptured saccular intracranial aneurysms.
268 patients with 286 saccular unruptured wide-necked intracranial aneurysms were treated at our institution with stent- or balloon-assisted coiling and retrospectively reviewed. Statistical analysis was performed to assess significant differences between the two groups.
The rate of complete occlusion at the end of the procedure was higher with stent-assisted coiling than with balloon-assisted coiling (86.8% vs 78%) and the same results were also observed after 6 months (92.1% vs 77.6%; p=0.05). About 50% of major recurrences occurred in large to giant aneurysms (p<0.001). The overall complication rate was similar in the stent-assisted and balloon-assisted groups (10.3% vs 9.3%). Independently of the technique, a higher complication rate was observed with bifurcational aneurysms, particularly in the middle cerebral artery (p=0.016).
Stent-assisted coiling achieved better results in terms of complete occlusion and stability than balloon-assisted coiling with a lower rate of recurrence without being associated with a higher risk of intraprocedural complications. Bifurcational and large to giant aneurysms were associated with higher complication rates and higher recurrence rates, respectively, and still represent a challenge for both techniques.
使用支架或球囊辅助栓塞能够以合理的并发症发生率实现更高比例的颅内未破裂囊状动脉瘤完全闭塞。本研究的目的是比较支架辅助栓塞和球囊重塑技术在治疗类似的未破裂颅内囊状动脉瘤时的疗效、稳定性及安全性。
对我院采用支架或球囊辅助栓塞治疗的268例患者的286个颅内未破裂宽颈囊状动脉瘤进行回顾性分析。进行统计学分析以评估两组之间的显著差异。
支架辅助栓塞术结束时的完全闭塞率高于球囊辅助栓塞术（86.8%对78%），6个月后结果相同（92.1%对77.6%；p=0.05）。约50%的主要复发发生在大型至巨大型动脉瘤中（p<0.001）。支架辅助组和球囊辅助组的总体并发症发生率相似（10.3%对9.3%）。无论采用何种技术，分叉处动脉瘤的并发症发生率更高，尤其是大脑中动脉处的动脉瘤（p=0.016）。
与球囊辅助栓塞术相比，支架辅助栓塞术在完全闭塞和稳定性方面取得了更好的效果，复发率更低，且术中并发症风险并未增加。分叉处动脉瘤和大型至巨大型动脉瘤分别与更高的并发症发生率和复发率相关，对这两种技术而言仍然是挑战。
