基底动脉尖动脉瘤复发、进展和再治疗的预测因素：基于位置的分析。
Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis.
机构信息
Department of Neurological Surgery, University of Washington, Seattle, Washington.
Department of Radiology, University of Washington, Seattle, Washington.
出版信息
Oper Neurosurg (Hagerstown). 2019 Apr 1;16(4):435-444. doi: 10.1093/ons/opy132.
BACKGROUND
Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described.
OBJECTIVE
To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions.
METHODS
We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan-Meier analysis was used to characterize 24-mo event rates for primary outcome prediction.
RESULTS
Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression.
CONCLUSION
BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.
背景
尽管基底尖动脉瘤（BTAs）的当代复发率和再治疗率的相关数据描述较少，但血管内治疗颅内动脉瘤与更高的复发率和再治疗率相关。
目的
描述接受显微手术或血管内介入治疗的 BTAs 的进展、再治疗和再治疗进展情况。
方法
我们回顾性分析了 141 例连续 BTA 患者的记录。我们将 158 例前交通动脉（ACoA）和 118 例大脑中动脉（MCA）动脉瘤作为对照。使用单变量和多变量分析计算进展（先前闭塞的动脉瘤复发和已知残留的动脉瘤瘤颈或瘤顶进展）、再治疗和再治疗进展的发生率。Kaplan-Meier 分析用于预测 24 个月的主要结局事件发生率。
结果
在 141 例 BTA 患者中，62.4%为破裂性动脉瘤，37.6%为未破裂性动脉瘤。平均影像学随访时间为 33 个月。在接受夹闭治疗的破裂性动脉瘤中，有 2 例因复发而再出血（6.1%），而其他各组均无再出血。手术和血管内治疗亚组之间进展（28.9%）、再治疗（28.9%）和再治疗进展（24.7%）的总体发生率无显著差异，但破裂性动脉瘤的事件发生率更高。多变量建模证实破裂状态（P=0.003，风险比=0.14）和动脉瘤瘤颈宽度（P=0.005，风险比=1.23）是需要再治疗的进展的独立预测因素。在另一项包含 ACoA 和 MCA 动脉瘤的多变量分析中，基底尖位置是进展、再治疗和再治疗进展的独立预测因素。
结论
与其他动脉瘤部位相比，BTAs 的进展和再治疗进展发生率更高，独立于治疗方式。破裂状态和瘤颈宽度是需要再治疗的进展的危险因素。
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