Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, Charleston, South Caroli-na.
Department of Public Health Sci-ences, Medical University of South Car-olina, Charleston, South Carolina.
Neurosurgery. 2018 Apr 1;82(4):516-524. doi: 10.1093/neuros/nyx240.
The prothrombotic milieu seen in subarachnoid hemorrhage (SAH) poses a unique challenge to neurovascular surgeons with regard to device use and microcatheter practice.
To determine how demographic factors and balloon practices impact diffusion-weighted imaging (DWI) abnormalities and outcomes in patients with SAH compared to those without (non-SAH).
We retrospectively analyzed 77 patients with SAH treated by balloon-assisted coiling in a single institution compared with 81 consecutive patients with unruptured aneurysms treated by balloon-assisted coiling at the same institution. Data were collected with regard to demographic factors, procedural and anatomic considerations, and DWI abnormalities on postprocedural magnetic resonance imaging.
SAH patients were significantly more likely to have DWI abnormality (75% vs 21%, P < .0001) and had a higher number and volume of DWI (4.0 vs 3.0, P = .0421 and 1.3 vs 0.3 cc, P = .0041) despite similar balloon practices. SAH patients were not more likely to have DWI abnormality in vascular territory distal to the treated aneurysm but had a higher likelihood of DWI in a vascular territory unrelated to the aneurysm (81.5% vs 47.1%, P = .0235). Patients without DWI abnormality were significantly more likely to have a good outcome as defined by modified Rankin Score 0 to 2 (95.6% vs 81.6%, P = .0328). Patients with DWI abnormality more often underwent 4-vessel angiography (70.5% vs 48.0%, P = .0174), but this was not found to be significant on multivariate analysis.
Balloon-assisted coiling does not result in increased incidence of downstream ischemic events in SAH patients compared to non-SAH patients and is safe in this cohort of patients. Other factors, such as 4-vessel angiography of the SAH milieu itself, may predispose patients to a higher rate of ischemic events.
蛛网膜下腔出血（SAH）中存在的促血栓形成环境对神经血管外科医生在使用器械和微导管方面提出了独特的挑战。
确定人口统计学因素和球囊操作如何影响接受球囊辅助弹簧圈栓塞治疗的 SAH 患者与未接受该治疗的非 SAH 患者的弥散加权成像（DWI）异常和结局。
我们回顾性分析了在单家机构接受球囊辅助弹簧圈栓塞治疗的 77 例 SAH 患者和在同一家机构接受球囊辅助弹簧圈栓塞治疗的 81 例未破裂动脉瘤患者的资料。收集了人口统计学因素、手术和解剖学注意事项以及术后磁共振成像上的 DWI 异常等数据。
SAH 患者的 DWI 异常发生率明显更高（75%比 21%，P<0.0001），且 DWI 的数量和体积也更高（4.0 比 3.0，P=0.0421；1.3 比 0.3 cc，P=0.0041），尽管球囊操作相似。SAH 患者在治疗动脉瘤远端的血管区域发生 DWI 异常的可能性不高，但在与动脉瘤无关的血管区域发生 DWI 异常的可能性更高（81.5%比 47.1%，P=0.0235）。无 DWI 异常的患者更有可能获得良好的结局（改良Rankin 评分 0~2 分，95.6%比 81.6%，P=0.0328）。DWI 异常患者更常接受 4 血管造影（70.5%比 48.0%，P=0.0174），但多变量分析并未发现这具有统计学意义。
与非 SAH 患者相比，球囊辅助弹簧圈栓塞不会增加 SAH 患者下游缺血性事件的发生率，在该患者人群中是安全的。其他因素，如 SAH 环境的 4 血管造影，可能使患者更容易发生更高的缺血性事件发生率。
