Bender Matthew T, Wendt Haley, Monarch Thomas, Lin Li-Mei, Jiang Bowen, Huang Judy, Coon Alexander L, Tamargo Rafael J, Colby Geoffrey P
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, University of California Irvine, Orange, California, USA.
World Neurosurg. 2017 Oct;106:919-924. doi: 10.1016/j.wneu.2017.07.074. Epub 2017 Jul 20.
Since the introduction of Gugliemi detachable coils in the early 1990s, major clinical studies have supported an increasing role for coil embolization of ruptured aneurysms. We assessed aneurysm location and treatment modality in aneurysmal subarachnoid hemorrhage (aSAH) over the past 25 years.
A prospective, institutional review board-approved aneurysm database was screened for patients presenting with aSAH from 1991 to 2016. Microsurgical and endovascular capabilities were present throughout. All patients underwent cerebral angiography prior to treatment.
Data were available for 1306/1562 patients (83.6%) presenting with aSAH from 1991-2016. 72% were female, with average age 52.8 years, and average aneurysm size 8.0 mm. The most common vessel of origin was the anterior cerebral artery (37.3%), internal carotid artery (33.3%), and middle cerebral artery (14.6%). Posterior circulation accounted for 14.8% of the aneurysms. Open surgery was performed for 72.4% of aneurysms, endovascular treatment for 22.0%, and 5.7% were not treated. There was an increase in aneurysms treated by endovascular methods over 5-year intervals: 3.0% (1991-1996), 13.4% (1997-2001), 17.2% (2002-2006), 24.3% (2007-2011), and 41.9% (2012-2016). Posterior circulation aneurysms led this trend, increasing from 9.1% endovascular to 71.4%. Endovascular treatment increased from 2.9% and 1.4% of anterior cerebral artery and internal carotid artery aneurysms to 39.6% and 40.7%, respectively, in the most recent 5-year interval. By comparison, endovascular methods remained less commonly used for middle cerebral artery aneurysms (0% initially, now 22.0%).
Endovascular treatment of ruptured intracranial aneurysms has steadily increased over the past 25 years at our major academic institution. This is consistent with positive data from clinical trials, advances in endovascular technology, and increasing experience of endovascular specialists.
自20世纪90年代初引入 Gugliemi 可脱卸弹簧圈以来，主要临床研究支持弹簧圈栓塞破裂动脉瘤的作用日益增加。我们评估了过去25年中动脉瘤性蛛网膜下腔出血（aSAH）的动脉瘤位置和治疗方式。
对一个前瞻性、经机构审查委员会批准的动脉瘤数据库进行筛查，以找出1991年至2016年期间出现aSAH的患者。整个期间均具备显微外科和血管内治疗能力。所有患者在治疗前均接受了脑血管造影。
有1306/1562例（83.6%）1991 - 2016年出现aSAH的患者的数据可用。72%为女性，平均年龄52.8岁，平均动脉瘤大小8.0mm。最常见的起源血管是大脑前动脉（37.3%）、颈内动脉（33.3%）和大脑中动脉（14.6%）。后循环动脉瘤占动脉瘤的14.8%。72.4%的动脉瘤采用开放手术治疗，22.0%采用血管内治疗，5.7%未治疗。在5年间隔期内，采用血管内方法治疗的动脉瘤有所增加：3.0%（1991 - 1996年）, 13.4%（1997 - 2001年）, 17.2%（2002 - 2006年）, 24.3%（2007 - 2011年）, 41.9%（2012 - 2016年）。后循环动脉瘤引领了这一趋势，从血管内治疗的9.1%增加到71.4%。在最近的5年间隔期内，血管内治疗分别从前交通动脉和颈内动脉动脉瘤的2.9%和1.4%增加到39.6%和40.7%。相比之下，血管内方法在大脑中动脉动脉瘤中仍较少使用（最初为0%，现在为22.0%）。
在我们的主要学术机构，过去25年中破裂颅内动脉瘤的血管内治疗稳步增加。这与临床试验的阳性数据、血管内技术的进步以及血管内专家经验的增加是一致的。
