Liang Fei, Zhang Yupeng, Guo Feng, Zhang Yuxiang, Yan Peng, Liang Shikai, Jiang Yuhua, Jiang Peng, Jiang Chuhan
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
World Neurosurg. 2018 Apr;112:e683-e690. doi: 10.1016/j.wneu.2018.01.129. Epub 2018 Feb 2.
To evaluate the performance of the Pipeline embolization device (PED) for posterior circulation aneurysms.
From November 2015 to November 2016, 35 patients with 38 posterior circulation aneurysms were treated with the PED in this retrospective study. We evaluated the angiographic and clinical outcomes of these aneurysms at last follow-up, and made a comparison between anterior (n = 163) and posterior circulation (n = 38) aneurysms regarding the technical nuances, occlusion rate, complications rate, and time to occlusion to explore whether we should rationalize the use of the PED for these aneurysms.
With a median follow-up time of 5.5 months, complete occlusion was achieved in 33 aneurysms (91.7%). Aneurysms with stenosis parent artery tended to have lower occlusion rate (P = 0.064; odds ratio, 0.074; 90% confidence interval, 0.001-1.781), and V4 segment aneurysms tended to occlude themselves much faster than vertebrobasilar junction aneurysms (median, 148 vs. 246 days, respectively; P = 0.076). The periprocedural complication rate was 10.8%, and no major adverse events occurred. Compared with anterior circulation aneurysms, shorter procedure time (116.0 vs. 135.4 minutes, P = 0.012) and higher occlusion rate (91.4% vs. 72.8%, P = 0.023) were achieved for posterior circulation aneurysms. Besides, technical event rate (8.1% vs. 14.1%, P = 0.424) and complication rate (10.8% vs. 18.4%, P = 0.338) tended to be lower. Survival analysis indicated a shorter interval to complete occlusion for V4 segment aneurysms compared with anterior circulation (148 vs. 191 days, respectively; P = 0.047).
PED has a favorable performance at posterior circulation, and it is rational to expand the indication to include these aneurysms. However, a case-control study is still needed to further expatiate whether the PED has advantages over traditional endovascular treatment.
评估管道栓塞装置（PED）治疗后循环动脉瘤的性能。
在这项回顾性研究中，从2015年11月至2016年11月，对35例患有38个后循环动脉瘤的患者使用PED进行治疗。我们在末次随访时评估了这些动脉瘤的血管造影和临床结果，并在前循环（n = 163）和后循环（n = 38）动脉瘤之间比较了技术细节、闭塞率、并发症发生率和闭塞时间，以探讨是否应合理使用PED治疗这些动脉瘤。
中位随访时间为5.5个月，33个动脉瘤（91.7%）实现了完全闭塞。载瘤动脉有狭窄的动脉瘤闭塞率往往较低（P = 0.064；比值比，0.074；90%置信区间，0.001 - 1.781），V4段动脉瘤的自行闭塞速度往往比椎基底动脉交界区动脉瘤快得多（中位数分别为148天和246天；P = 0.076）。围手术期并发症发生率为10.8%，未发生重大不良事件。与前循环动脉瘤相比，后循环动脉瘤的手术时间更短（116.0对135.4分钟，P = 0.012），闭塞率更高（91.4%对72.8%，P = 0.023）。此外，技术事件发生率（8.1%对14.1%，P = 0.424）和并发症发生率（10.8%对18.4%，P = 0.338）趋于更低。生存分析表明，与前循环相比，V4段动脉瘤完全闭塞的间隔时间更短（分别为148天和191天；P = 0.047）。
PED在后循环中表现良好，将适应证扩大到包括这些动脉瘤是合理的。然而，仍需要一项病例对照研究来进一步阐述PED是否优于传统血管内治疗。
