Gentric Jean-Christophe, Biondi Alessandra, Piotin Michel, Mounayer Charbel, Lobotesis Kyriakos, Bonafé Alain, Costalat Vincent
*CHUM Montréal, Neuroradiology, Montréal, Québec, Canada; ‡Université de Bretagne Occidentale, Groupe d'étude de la Thrombose en Bretagne Occidentale (EA 3878, GETBO), Brest, France; §CHU Besançon, Department of Neuroradiology and Endovascular Therapy, Besançon, France; ¶Fondation Ophtalmologique Adolphe de Rothschild, Neuroradiology, Paris, France; ‖CHU Dupuytren, Neuroradiology, Limoges, France; #Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital; **CHU Montpellier, Neuroradiology, Montpellier, France.
Neurosurgery. 2015 Apr;76(4):441-5; discussion 445. doi: 10.1227/NEU.0000000000000639.
Endovascular treatment of wide-necked and complex aneurysms may require stent-assisted coiling, either as primary stenting or combined with the balloon remodeling technique (BRT).
To compare the angiographic results and clinical outcomes of both strategies in the Safety and Efficacy of Neuroform for Treatment of intracranial Aneurysms (SENAT) registry.
SENAT was a prospective, multicenter registry that allowed BRT in conjunction with stenting and coiling with bare platinum coils. Clinical and angiographic outcomes of 97 patients with unruptured aneurysms treated with stenting, 51 after BRT (BRT+) and 46 without balloon assistance (BRT-), were retrieved from the SENAT database. Technical, clinical, and angiographic outcomes were compared between the 2 groups.
Periprocedural morbimortality and midterm clinical outcomes were not different between groups. Residual aneurysms were observed in 7.8% of BRT+ and in 21.7% of BRT- (P = .08) at the end of the stenting procedure. Four retreatments were performed during the follow-up period (2 BRT+, 2 BRT-). Twelve- to 18-month anatomic results showed a significant difference between groups, with a residual aneurysm being observed in 6.1% of BRT+ as compared to 22.7% of BRT- patients (P = .03).
Primary BRT followed by stent-assisted coiling may be associated with fewer residual aneurysms at 12 to 18 months as compared to stent-assisted coiling alone.
宽颈和复杂动脉瘤的血管内治疗可能需要支架辅助弹簧圈栓塞,可采用单纯支架置入术或联合球囊重塑技术(BRT)。
在Neuroform治疗颅内动脉瘤安全性和有效性(SENAT)注册研究中比较这两种策略的血管造影结果和临床结局。
SENAT是一项前瞻性多中心注册研究,允许BRT联合支架置入术以及使用裸铂金弹簧圈进行弹簧圈栓塞。从SENAT数据库中检索97例未破裂动脉瘤患者的临床和血管造影结局,其中51例接受BRT联合支架置入术(BRT+组),46例未接受球囊辅助(BRT-组)。比较两组的技术、临床和血管造影结局。
两组围手术期病死率和中期临床结局无差异。在支架置入术结束时,BRT+组7.8%的患者和BRT-组21.7%的患者观察到残余动脉瘤(P = 0.08)。随访期间进行了4次再次治疗(2例BRT+组,2例BRT-组)。12至18个月的解剖学结果显示两组间存在显著差异,BRT+组6.1%的患者观察到残余动脉瘤,而BRT-组为22.7%(P = 0.03)。
与单纯支架辅助弹簧圈栓塞相比,先行BRT再行支架辅助弹簧圈栓塞在12至18个月时可能与较少的残余动脉瘤相关。