Park M S, Kilburg C, Taussky P, Albuquerque F C, Kallmes D F, Levy E I, Jabbour P, Szikora I, Boccardi E, Hanel R A, Bonafé A, McDougall C G
From the Department of Neurosurgery (M.S.P., C.K., P.T.), University of Utah Health Care, Salt Lake City, Utah.
Department of Neurosurgery (F.C.A., C.G.M.), Barrow Neurological Institute, Phoenix, Arizona.
AJNR Am J Neuroradiol. 2016 Jun;37(6):1127-31. doi: 10.3174/ajnr.A4678. Epub 2016 Jan 14.
Flow diversion to treat cerebral aneurysms has revolutionized neurointerventional surgery. Because the addition of coils potentially increases the time and complexity of endovascular procedures, we sought to determine whether adjunctive coil use is associated with an increase in complications. Patients in the International Retrospective Study of Pipeline Embolization Device registry were divided into those treated with the Pipeline Embolization Device alone (n = 689 patients; n = 797 aneurysms; mean aneurysm size, 10.3 ± 7.6 mm) versus those treated with the Pipeline Embolization Device and concurrent coil embolization (n = 104 patients; n = 109 aneurysms; mean aneurysm size, 13.6 ± 7.8 mm). Patient demographics and aneurysm characteristics were examined. Rates of neurologic morbidity and mortality were compared between groups. The Pipeline Embolization Device with versus without coiling required a significantly longer procedure time (135.8 ± 63.9 versus 96.7 ± 46.2 min; P < .0001) and resulted in higher neurological morbidity (12.5% versus 7.8%; P = .13). These data suggest that either strategy represents an acceptable risk profile in the treatment of complex cerebral aneurysms and warrants further investigation.
血流导向治疗脑动脉瘤彻底改变了神经介入手术。由于增加弹簧圈可能会延长血管内手术的时间并增加其复杂性，我们试图确定辅助使用弹簧圈是否会增加并发症的发生率。国际管道栓塞装置回顾性研究登记处的患者被分为单纯接受管道栓塞装置治疗的患者（n = 689例患者；n = 797个动脉瘤；平均动脉瘤大小为10.3±7.6 mm）与接受管道栓塞装置并同时进行弹簧圈栓塞治疗的患者（n = 104例患者；n = 109个动脉瘤；平均动脉瘤大小为13.6±7.8 mm）。对患者人口统计学和动脉瘤特征进行了检查。比较了两组之间的神经功能缺损率和死亡率。使用与未使用弹簧圈的管道栓塞装置相比，手术时间显著更长（135.8±63.9对96.7±46.2分钟；P <.0001），并且导致更高的神经功能缺损率（12.5%对7.8%；P = 0.13）。这些数据表明，这两种策略在治疗复杂脑动脉瘤方面均代表了可接受的风险状况，值得进一步研究。
