Johnson Andrew Kelly, Munich Stephan A, Tan Lee A, Heiferman Daniel Mark, Keigher Kiffon Marie, Lopes Demetrius Klee
Department of Neurosurgery, Rush University Medical Center, Chicago; and.
Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
J Neurosurg. 2015 Aug;123(2):453-9. doi: 10.3171/2014.10.JNS141361. Epub 2015 May 15.
Stent-assisted embolization (SAE) has broadened the scope of endovascular cerebral aneurysm treatment. The risks associated with stent selection and configuration are poorly defined. In this study, the authors aimed to characterize the risk factors that contribute to complications in SAE of intracranial aneurysms.
Over a 10-year period, a single surgeon treated 486 aneurysms with SAE in which open-cell Neuroform or closed-cell Enterprise stents were used. Single stents were used in 386 cases, overlapping stents were deployed in 80 cases, and Y-configuration stents were used in the remaining 20 cases. All neurological complications, which included transient deficits, were analyzed; disabling strokes and death were considered major complications. The chi-square test and multivariate logistic regression were used to evaluate the influence of aneurysm size and morphology, aneurysm location, stent selection, and stent configuration on complication rates.
There were 7 deaths (1.4%), 9 major strokes (1.9%), and 18 minor neurological complications (3.7%). For all complications, multivariate analysis revealed that large aneurysm size (10-25 mm; p = 0.01), giant aneurysm size (> 25 mm; p = 0.04), fusiform aneurysm morphology (p = 0.03), and using a Y-configuration stent (p = 0.048) were independent risk factors. For the major complications, independent risk factors included an aneurysm in the posterior circulation (p = 0.02), using an overlapping stent configuration (p = 0.03), and using a Y-configuration stent (p < 0.01).
In this series, SAE for cerebral aneurysm treatment carried an acceptable complication rate. With continued innovations in techniques and devices and with increased experience, the complication rates associated with SAE may be even lower in the future.
支架辅助栓塞术（SAE）拓宽了颅内动脉瘤血管内治疗的范围。与支架选择和构型相关的风险定义尚不明确。在本研究中，作者旨在明确导致颅内动脉瘤SAE并发症的危险因素。
在10年期间，由一名外科医生使用开放式Neuroform支架或封闭式Enterprise支架对486例动脉瘤进行SAE治疗。386例使用单个支架，80例使用重叠支架，其余20例使用Y形构型支架。分析所有神经并发症，包括短暂性神经功能缺损；致残性卒中及死亡被视为主要并发症。采用卡方检验和多因素逻辑回归分析评估动脉瘤大小和形态、动脉瘤位置、支架选择及支架构型对并发症发生率的影响。
有7例死亡（1.4%），9例严重卒中（1.9%），18例轻微神经并发症（3.7%）。对于所有并发症，多因素分析显示，动脉瘤较大（10 - 25 mm；p = 0.01）、巨大动脉瘤（> 25 mm；p = 0.04）、梭形动脉瘤形态（p = 0.03）以及使用Y形构型支架（p = 0.048）是独立危险因素。对于主要并发症，独立危险因素包括后循环动脉瘤（p = 0.02）、使用重叠支架构型（p = 0.03）以及使用Y形构型支架（p < 0.01）。
在本系列研究中，SAE治疗脑动脉瘤的并发症发生率可接受。随着技术和器械的不断创新以及经验的增加，未来SAE相关的并发症发生率可能会更低。
