Brasiliense Leonardo B C, Aguilar-Salinas Pedro, Miller David A, Tawk Rabih G, Sauvageau Eric A, Hanel Ricardo A
Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA.
World Neurosurg. 2017 Nov;107:641-648. doi: 10.1016/j.wneu.2017.08.099. Epub 2017 Aug 24.
Although the Pipeline Embolization Device (PED) has proved to be an excellent option for internal carotid artery (ICA) aneurysms, the rate of occlusion remains difficult to predict and factors associated with aneurysm occlusion are not well elucidated. This study aimed to investigate predictors and the rate of occlusion for aneurysms along the ICA.
A total of 117 saccular ICA aneurysms treated with the PED were studied. Occlusion rates were divided among 4 groups: group A [lesions >10 mm in the proximal ICA (petrous to the superior hypophyseal segments)]; group B (lesions <10 mm in the proximal ICA); group C [lesions >10mm in the distal ICA (posterior communicating segment to the ICA bifurcation)]; and group D (lesions <10 mm in the distal ICA). Predictors of aneurysm occlusion were entered into a multivariate Cox regression analysis.
The median time to aneurysm occlusion was 8 months in group A (95% confidence interval [CI], 7.0-9.1), 5.2 months in group B (95% CI, 4.5-6.0), 6.9 months in group C (95% CI, 6.5-7.2), and 10.2 months in group D (95% CI, 6.9-13.6) (P = 0.045). There was a statistically significant difference between the probability of aneurysm occlusion in group B compared with distal ICA aneurysms (P = 0.02). Small proximal ICA aneurysms were more likely to occlude over time compared with other aneurysm groups (hazard ratio, 1.76; 95% CI, 1.07-2.9; P = 0.02).
The rate of occlusion after PED is highest for small proximal ICA aneurysms and the probability of occlusion is lower for distal ICA aneurysms.
尽管管道栓塞装置（PED）已被证明是治疗颈内动脉（ICA）动脉瘤的理想选择，但闭塞率仍难以预测，且与动脉瘤闭塞相关的因素尚未完全阐明。本研究旨在探讨ICA沿线动脉瘤的闭塞预测因素及闭塞率。
共研究了117例接受PED治疗的囊状ICA动脉瘤。闭塞率分为4组：A组[ICA近端（岩骨段至垂体上缘段）病变>10mm]；B组（ICA近端病变<10mm）；C组[ICA远端（后交通段至ICA分叉）病变>10mm]；D组（ICA远端病变<10mm）。将动脉瘤闭塞的预测因素纳入多因素Cox回归分析。
A组动脉瘤闭塞的中位时间为8个月（95%置信区间[CI]，7.0 - 9.1），B组为5.2个月（95%CI，4.5 - 6.0），C组为6.9个月（95%CI，6.5 - 7.2），D组为10.2个月（95%CI，6.9 - 13.6）（P = 0.045）。与ICA远端动脉瘤相比，B组动脉瘤闭塞概率有统计学显著差异（P = 0.02）。随着时间推移，ICA近端小动脉瘤比其他动脉瘤组更易闭塞（风险比，1.76；95%CI，1.07 - 2.9；P = 0.02）。
PED治疗后，ICA近端小动脉瘤的闭塞率最高，而ICA远端动脉瘤的闭塞概率较低。
