Moon Karam, Park Min S, Albuquerque Felipe C, Levitt Michael R, Mulholland Celene B, McDougall Cameron G
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Departments of Neurosurgery and Radiology, University of Utah, Salt Lake City, Utah.
Neurosurgery. 2017 Oct 1;81(4):581-584. doi: 10.1093/neuros/nyw051.
Approximately 17% of ruptured anterior communicating artery (ACoA) aneurysms were deemed unsuitable for coil embolization during the Barrow Ruptured Aneurysm Trial (BRAT), most commonly due to unfavorable dome-to-neck ratio or small size.
To compare patients treated by coil embolization for ruptured ACoA aneurysms during the trial to those treated after the trial to determine whether advances in endovascular techniques have allowed for effective treatment of these lesions.
All cases of ruptured ACoA aneurysms treated by endovascular modalities during BRAT (2003-2007) and post-BRAT (2007-2012) were reviewed for patient and aneurysm characteristics, treatment types, and clinical and angiographic outcomes at 3-yr or last follow-up.
The BRAT ACoA cohort included 39 patients treated with coiling (excluding those crossed over to clipping). The post-BRAT cohort included 93 patients who were significantly older (mean age, 59.5 vs 52.8 yr, P = .005) than the BRAT cohort; there were no significant cohort differences in sex, Hunt and Hess grade, or mean aneurysm size. The use of balloon remodeling was significantly higher in the post-BRAT cohort (31.2% [29/93] vs 5.1% [2/39], P = .001), as was the proportion of wide-necked aneurysms treated (66.7% [62/93] vs 30.8% [12/39], P < .001). There was no significant difference in clinical outcome or retreatment rate between the 2 cohorts (P = .90 and P = .48, respectively).
ACoA lesions thought unamenable to endovascular therapy in an earlier randomized trial are now successfully coiled with increased use of adjunctive techniques, without sacrificing patient outcome or treatment durability.
在巴罗破裂动脉瘤试验（BRAT）期间，约17%的前交通动脉（ACoA）破裂动脉瘤被认为不适合进行弹簧圈栓塞，最常见的原因是瘤顶与瘤颈比例不佳或尺寸较小。
比较试验期间接受弹簧圈栓塞治疗的ACoA破裂动脉瘤患者与试验后接受治疗的患者，以确定血管内技术的进步是否允许对这些病变进行有效治疗。
回顾了BRAT（2003 - 2007年）和BRAT后（2007 - 2012年）期间通过血管内方式治疗的所有ACoA破裂动脉瘤病例，以了解患者和动脉瘤特征、治疗类型以及3年或最后一次随访时的临床和血管造影结果。
BRAT的ACoA队列包括39例接受弹簧圈栓塞治疗的患者（不包括转为夹闭治疗的患者）。BRAT后队列包括93例患者，其年龄显著大于BRAT队列（平均年龄分别为59.5岁和52.8岁，P = 0.005）；在性别、Hunt和Hess分级或平均动脉瘤大小方面，队列之间无显著差异。BRAT后队列中球囊重塑的使用显著更高（31.2% [29/93] 对5.1% [2/39]，P = 0.001），治疗的宽颈动脉瘤比例也是如此（66.7% [62/93] 对30.8% [12/39]，P < 0.001）。两个队列之间的临床结果或再治疗率无显著差异（分别为P = 0.90和P = 0.48）。
在早期随机试验中被认为不适合血管内治疗的ACoA病变，现在通过增加辅助技术的使用成功地进行了弹簧圈栓塞，而不会牺牲患者的预后或治疗持久性。
