Ghinda Diana, Dos Santos Marlise Peruzzo, Sabri Armin, Iancu Daniela, Lum Cheemun, Lesiuk Howard J
Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Canada.
Neuroradiology Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada
Interv Neuroradiol. 2015 Apr;21(2):146-54. doi: 10.1177/1591019915582152. Epub 2015 May 7.
Despite the increasing use of stent-assisted coiling (SAC), data on its long-term clinical and angiographic results are limited.
The objective of this article is to assess the long-term clinical and angiographic outcomes in SAC in our single-center practice.
We conducted a retrospective analysis of intracranial aneurysms treated with detachable coils during the period 2003-2012. Patients were divided into SAC and non-SAC groups and were analyzed for aneurysm occlusion, major recurrence and clinical outcome. Logistic regression analyses identified factors associated with clinical/angiographic outcomes (p value <0.05 was statistically significant).
A total of 516 procedures met inclusion criteria: Sixty-three (12.2%) patients underwent SAC, of whom 56 (89%) had an elective procedure whereas 286 (63.1%) aneurysms from the non-SAC group were ruptured. In the unruptured subcohort, baseline class I was achieved in 24 (38%, p = 0.91), and predischarge modified Rankin scale score (mRS) 0-2 was obtained in 96.4% of cases in the SAC group versus 90.4% in the non-stent group. The major recurrence was 9.5% versus 11.3% in the SAC and non-SAC group, respectively (p = 0.003). At last clinical assessment, 98.2% of the patients from the unruptured SAC group had mRS 0-2 (mean follow-up, 58 months) versus 93.6% (mean follow-up, 56 months) in the unruptured non-SAC group (p = 0.64). Periprocedural vasospasm was associated with long-term poor outcome in the unruptured SAC subcohort (p = 0.0008).
SAC and non-SCA techniques show comparable safety and clinical outcome. The SAC technique significantly decreases retreatment rates. Periprocedural vasospasm resulting from vessel manipulation is associated with poor outcome in SAC of unruptured aneurysms.
尽管支架辅助弹簧圈栓塞术（SAC）的应用日益增多，但其长期临床和血管造影结果的数据有限。
本文的目的是评估在我们单中心实践中SAC的长期临床和血管造影结果。
我们对2003年至2012年期间采用可脱卸弹簧圈治疗的颅内动脉瘤进行了回顾性分析。患者被分为SAC组和非SAC组，并分析动脉瘤闭塞情况、主要复发情况和临床结果。逻辑回归分析确定与临床/血管造影结果相关的因素（p值<0.05具有统计学意义）。
共有516例手术符合纳入标准：63例（12.2%）患者接受了SAC，其中56例（89%）为择期手术，而非SAC组有286例（63.1%）动脉瘤破裂。在未破裂亚组中，SAC组24例（38%，p = 0.91）达到基线I级，出院前改良Rankin量表评分（mRS）0 - 2分的病例在SAC组为96.4%，非支架组为90.4%。SAC组和非SAC组的主要复发率分别为9.5%和11.3%（p = 0.003）。在最后一次临床评估时，未破裂SAC组98.2%的患者mRS为0 - 2分（平均随访58个月），未破裂非SAC组为93.6%（平均随访56个月）（p = 0.64）。围手术期血管痉挛与未破裂SAC亚组的长期不良结局相关（p = 0.0008）。
SAC和非SCA技术显示出相当的安全性和临床结果。SAC技术显著降低了再治疗率。血管操作导致的围手术期血管痉挛与未破裂动脉瘤SAC的不良结局相关。
