Linzey Joseph R, Griauzde Julius, Guan Zhe, Bentley Nicole, Gemmete Joseph J, Chaudhary Neeraj, Thompson B Gregory, Pandey Aditya S
University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
J Neurointerv Surg. 2017 Nov;9(11):1081-1085. doi: 10.1136/neurintsurg-2016-012704. Epub 2016 Oct 3.
Stent-assisted coiling is commonly used to treat wide-necked and fusiform cerebral aneurysms. We evaluated our institutional experience with stent-assisted coiling of cerebral aneurysms to elucidate potential risk factors for recurrence.
A retrospective analysis of patients undergoing stent-assisted coiling of cerebral aneurysms from 2005 to 2012 resulted in 122 patients with 122 aneurysms. Demographic, peri-procedural, medical comorbidity, and follow-up data were collected. Primary outcomes of interest were procedural safety, efficacy, and aneurysm recurrence. Univariate and multivariate logistic regression and χ tests determined the statistical significance of the risk factors.
All 122 stent-assisted coiling procedures led to satisfactory obliteration of the aneurysm (3.3% complication rate). Twenty-one (17.2%) patients experienced recurrence at average follow-up of 297 days. Fifteen (71.4%) clinically significant recurrences required retreatment. Eleven of 30 (36.7%) procedures using Enterprise stents had recurrence compared with only 10 of 92 (10.9%) procedures using Neuroform stents (p=0.001). Average coiling packing density (PD) was 20.3% with Enterprise stents and 22.5% with Neuroform stents (p=0.8). In multivariate logistic regression, recurrences requiring recoiling were significantly associated with Enterprise stents (OR 8.57, 95% CI 1.97 to 37.19; p=0.004), females (OR 0.19, 95% CI 0.04 to 1.00; p=0.05), and postoperative dextran use (OR 8.42, 95% CI 1.40 to 50.58; p=0.02). Aneurysms with <20% PD were more likely to have a clinically significant recurrence than aneurysms with >20% PD (19% vs 5.1%; p=0.02).
Stent-assisted coiling for wide-necked cerebral aneurysms has a high therapeutic success rate with low procedure-related morbidity and mortality. Clinically significant recurrences may occur more frequently with Enterprise stents, in aneurysms with low PD, and with post-procedural dextran use.
支架辅助弹簧圈栓塞术常用于治疗宽颈和梭形脑动脉瘤。我们评估了我院在脑动脉瘤支架辅助弹簧圈栓塞术方面的经验，以阐明复发的潜在危险因素。
对2005年至2012年接受脑动脉瘤支架辅助弹簧圈栓塞术的患者进行回顾性分析，共纳入122例患者的122个动脉瘤。收集了人口统计学、围手术期、合并症及随访数据。主要关注的结果是手术安全性、有效性及动脉瘤复发情况。单因素和多因素逻辑回归分析以及χ检验确定了危险因素的统计学意义。
所有122例支架辅助弹簧圈栓塞术均使动脉瘤达到满意的闭塞效果（并发症发生率为3.3%）。21例（17.2%）患者在平均297天的随访中出现复发。15例（71.4%）具有临床意义的复发需要再次治疗。使用Enterprise支架的30例手术中有11例（36.7%）复发，而使用Neuroform支架的92例手术中仅有10例（10.9%）复发（p = 0.001）。Enterprise支架的平均弹簧圈填充密度（PD）为20.3%，Neuroform支架为22.5%（p = 0.8）。在多因素逻辑回归分析中，需要再次栓塞的复发与Enterprise支架（比值比8.57，95%可信区间1.97至37.19；p = 0.004）、女性（比值比0.19，95%可信区间0.04至1.00；p = 0.05）及术后使用右旋糖酐（比值比8.42，95%可信区间1.40至50.58；p = 0.02）显著相关。PD<20%的动脉瘤比PD>20%的动脉瘤更易发生具有临床意义的复发（19%对5.1%；p = 0.02）。
宽颈脑动脉瘤的支架辅助弹簧圈栓塞术具有较高的治疗成功率，手术相关的发病率和死亡率较低。使用Enterprise支架、PD较低的动脉瘤以及术后使用右旋糖酐时，具有临床意义的复发可能更频繁发生。
