From Université Paris-Descartes, INSERM UMR 894, Department of Neuroradiology (A.L., C.R.R., F.A.S., D.T., S.G.H., W.B.H., J.F.M., C.O., O.N.N.), Centre Hospitalier Sainte-Anne, Paris and the International Consortium of Neuroendovascular Centres, Interventional Neuroradiology Research Unit, Department of Radiology, University of Montreal, CHUM Notre-Dame Hospital, Montreal, QC, Canada (J.R.).
Radiology. 2015 Oct;277(1):173-80. doi: 10.1148/radiol.2015142496. Epub 2015 Jun 9.
To assess the efficacy of endovascular treatment (EVT) of intracranial aneurysms for recurrence, bleeding, and de novo aneurysm formation at long-term follow-up (> 10 years after treatment) with magnetic resonance (MR) angiography and to identify risk factors for recurrence through a prospective study and a systematic review of the literature.
Clinical examinations and 3-T MR angiography were performed prospectively 10 years after EVT of intracranial aneurysms in a single institution. Ethics committee approval and informed consent were obtained. PubMed, EMBASE, and Cochrane databases were searched to identify studies in which authors reported bleeding and/or aneurysm recurrence rates in patients who received follow-up more than 10 years after EVT. Univariate and multivariate subgroup analyses were performed to identify risk factors (midterm MR angiographic results, aneurysm characteristics, retreatment within 5 years).
In the prospective study, sac recanalization occurred between midterm and long-term MR angiography in 16 of 129 (12.4%) aneurysms. Grade 2 classification on the Raymond scale at midterm MR angiography (relative risk [RR], 4.16; 99% confidence interval [CI]: 2.12, 8.14) and retreatment within 5 years (RR, 4.67; 99% CI: 1.55, 14.03) were risk factors for late recurrence. In the systematic review (15 cohorts, 2773 patients, 2902 aneurysms), bleeding, aneurysm recurrence, and de novo lesion formation rates were, respectively, 0.7% (99% CI: 0.2%, 2.7%; I(2), 0%; one of 694 patients), 11.4% (99% CI: 7.0%, 18.0%; I(2), 21.6%), and 4.1% (99% CI: 1.7, 9.4%; I(2), 54.1%). Raymond grade 2 initial result (RR, 7.08; 99% CI: 1.24, 40.37; I(2), 82.6%) and aneurysm size greater than 10 mm (RR, 4.37; 99% CI: 1.83, 10.44; I(2), 0%) were risk factors for late recurrence.
EVT of intracranial aneurysm is effective for prevention of long-term bleeding, but recurrences occur in a clinically relevant percentage of patients, a finding that may justify follow-up of selected patients for 10 years or more, such as patients with aneurysms larger than 10 mm or classified as Raymond grade 2 at midterm MR angiography.
通过前瞻性研究和对文献的系统回顾，使用磁共振（MR）血管造影评估颅内动脉瘤血管内治疗（EVT）后 10 年以上的复发、出血和新形成的动脉瘤的疗效，并确定复发的危险因素。
在一家机构内对颅内动脉瘤 EVT 后 10 年进行临床检查和 3-T MR 血管造影。获得伦理委员会批准和知情同意。在 PubMed、EMBASE 和 Cochrane 数据库中搜索，以确定作者在 EVT 后随访超过 10 年的患者中报告出血和/或动脉瘤复发率的研究。进行单变量和多变量亚组分析，以确定危险因素（中期 MR 血管造影结果、动脉瘤特征、5 年内再次治疗）。
在前瞻性研究中，129 个动脉瘤中有 16 个（12.4%）在中期和长期 MR 血管造影之间出现囊再通。中期 MR 血管造影时 Raymond 分级 2 级（相对风险 [RR]，4.16；99%置信区间 [CI]：2.12，8.14）和 5 年内再次治疗（RR，4.67；99%CI：1.55，14.03）是晚期复发的危险因素。在系统评价（15 个队列，2773 例患者，2902 个动脉瘤）中，出血、动脉瘤复发和新发病变的发生率分别为 0.7%（99%CI：0.2%，2.7%；I²，0%；694 例患者中有 1 例）、11.4%（99%CI：7.0%，18.0%；I²，21.6%）和 4.1%（99%CI：1.7%，9.4%；I²，54.1%）。初始 Raymond 分级 2 级结果（RR，7.08；99%CI：1.24，40.37；I²，82.6%）和动脉瘤大小大于 10mm（RR，4.37；99%CI：1.83，10.44；I²，0%）是晚期复发的危险因素。
颅内动脉瘤 EVT 对预防长期出血有效，但在临床相关比例的患者中会出现复发，这一发现可能证明对某些患者进行 10 年或更长时间的随访是合理的，例如动脉瘤直径大于 10mm 或中期 MR 血管造影时 Raymond 分级为 2 级的患者。
