Chalouhi Nohra, Daou Badih, Barros Guilherme, Starke Robert M, Chitale Ameet, Ghobrial George, Dalyai Richard, Hasan David, Gonzalez L Fernando, Tjoumakaris Stavropoula, Rosenwasser Robert H, Jabbour Pascal
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
Department of Neurosurgery & Radiology, Miami Miller School of Medicine, Miami University Hospital.
Neurosurgery. 2017 Jul 1;81(1):92-97. doi: 10.1093/neuros/nyw070.
Flow diversion is typically reserved for large, giant, or morphologically complex aneurysms. Coiling remains a first-line treatment for small, morphologically simple aneurysms.
To compare coiling and flow diversion in small, uncomplicated intracranial aneurysms (typically amenable to coiling).
Forty patients treated with the pipeline embolization device (PED) for small (<10 mm), morphologically simple aneurysms that would have also been amenable to coiling were identified. These patients were matched in a 1:1 fashion with 40 patients with comparable aneurysms treated with coiling. Matching was based on age, gender, aneurysm size, and aneurysm morphology.
The 2 groups were comparable with regard to baseline characteristics including age, gender, and aneurysm size. The complication rate did not differ between the 2 groups (2.5% with coiling vs 5% with PED; P = .6). Multivariate analysis did not identify any predictor of complications. Complete occlusion (100%) at follow-up was significantly higher in patients treated with PED (70%) than coiling (47.5%, P = .04). In multivariate analysis, treatment with PED predicted aneurysm obliteration ( P = .04). A significantly higher proportion of coiled patients (32.5%) required retreatment compared with flow diversion (5%, P = .003). In multivariate analysis, coiling predicted retreatment ( P = .006). All patients achieved a favorable outcome (modified Rankin Scale: 0-2) regardless of group.
This matched analysis suggests that flow diversion provides higher occlusion rates, lower retreatment rates, and no additional morbidity compared with coiling in small, simple aneurysms amenable to both techniques. These results suggest a potential benefit for flow diversion over coiling even in small, uncomplicated aneurysms.
血流导向通常用于大型、巨大型或形态复杂的动脉瘤。对于小型、形态简单的动脉瘤，弹簧圈栓塞仍是一线治疗方法。
比较小型、无并发症的颅内动脉瘤（通常适合弹簧圈栓塞）采用弹簧圈栓塞和血流导向治疗的效果。
确定40例使用管道栓塞装置（PED）治疗小型（<10 mm）、形态简单且原本也适合弹簧圈栓塞的动脉瘤患者。这些患者与40例接受弹簧圈栓塞治疗的具有类似动脉瘤的患者进行1:1匹配。匹配基于年龄、性别、动脉瘤大小和动脉瘤形态。
两组在年龄、性别和动脉瘤大小等基线特征方面具有可比性。两组的并发症发生率无差异（弹簧圈栓塞组为2.5%，PED组为5%；P = 0.6）。多因素分析未发现任何并发症预测因素。随访时完全闭塞（100%）的PED治疗患者比例（70%）显著高于弹簧圈栓塞组（47.5%，P = 0.04）。在多因素分析中，PED治疗可预测动脉瘤闭塞（P = 0.04）。与血流导向组（5%）相比，弹簧圈栓塞组需要再次治疗的患者比例显著更高（32.5%，P = 0.003）。在多因素分析中，弹簧圈栓塞可预测再次治疗（P = 0.006）。无论在哪一组，所有患者均获得了良好的预后（改良Rankin量表评分：0 - 2）。
这项匹配分析表明，对于两种技术均适用的小型、简单动脉瘤，与弹簧圈栓塞相比，血流导向具有更高的闭塞率、更低的再次治疗率且无额外的发病率。这些结果表明，即使在小型、无并发症的动脉瘤中，血流导向相对于弹簧圈栓塞也可能具有潜在优势。
