Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
The Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Neurointerv Surg. 2018 Jul;10(Suppl 1):i69-i76. doi: 10.1136/jnis.2011.004978.rep.
Integration of data from clinical trials and advancements in technology predict a change in selection for treatment of patients with cerebral aneurysm.
To describe patterns of use and in-hospital mortality associated with surgical and endovascular treatments of cerebral aneurysms over the past decade.
The data are 34 899 hospital discharges with a diagnosis of ruptured or unruptured cerebral aneurysm from 1998 to 2007 identified from the Nationwide Inpatient Sample (NIS). The rates of endovascular coiling and surgical clipping and in-hospital mortality among patients with an aneurysm are examined over a decade by hospital and patient demographic characteristics.
From 1998 to 2007, 20 134 discharges with a ruptured aneurysm and 14 765 discharges with an unruptured aneurysm were identified. Over this decade, the number of patients discharged with a ruptured aneurysm was stable while the number discharged with an unruptured aneurysm increased significantly. The use of endovascular coiling increased at least twofold for both groups of patient (p<0.001) with the majority of unruptured aneurysms treated with coiling by 2007. Although whites were more likely than non-whites to undergo coiling versus clipping for a ruptured aneurysm (OR=1.30; 95% CI 1.13 to 1.48) and men with unruptured aneurysms were more likely than women to undergo coiling (OR=1.26; 95% CI 1.13 to 1.40), by 2007 differences in treatment selection by gender and racial subgroups were decreased or statistically non-significant. Over time the use of coiling spread from primarily large, teaching hospitals to smaller, non-teaching hospitals.
The majority of unruptured aneurysms in the USA are now treated with endovascular coiling. Although surgical clipping is used for treatment of most ruptured aneurysms, its use is decreasing over time. Dissemination of endovascular procedures appears widespread across patient and hospital subgroups.
临床试验数据的整合和技术的进步预示着治疗脑动脉瘤患者的选择将会发生变化。
描述过去十年中治疗破裂和未破裂脑动脉瘤的手术和血管内治疗的使用模式和院内死亡率。
这项研究的数据来自于 1998 年至 2007 年全美住院患者样本（NIS）中 34899 例诊断为破裂或未破裂脑动脉瘤的住院患者。通过医院和患者人口统计学特征，在过去十年中，检查了接受动脉瘤治疗的患者中血管内线圈和手术夹闭的比例以及院内死亡率。
1998 年至 2007 年，共发现 20134 例破裂性动脉瘤和 14765 例未破裂性动脉瘤患者出院。在这十年中，破裂性动脉瘤出院患者的数量保持稳定，而未破裂性动脉瘤出院患者的数量显著增加。两组患者的血管内线圈使用量均增加了至少两倍（p<0.001），到 2007 年，大多数未破裂性动脉瘤都采用线圈治疗。尽管白人接受破裂性动脉瘤血管内线圈治疗的可能性高于非白人（OR=1.30；95%CI 1.13 至 1.48），且男性未破裂性动脉瘤患者接受线圈治疗的可能性高于女性（OR=1.26；95%CI 1.13 至 1.40），但到 2007 年，性别和种族亚组的治疗选择差异已缩小或无统计学意义。随着时间的推移，线圈治疗的应用范围从主要的大型教学医院扩展到较小的非教学医院。
在美国，大多数未破裂性动脉瘤现在都采用血管内线圈治疗。虽然手术夹闭是治疗大多数破裂性动脉瘤的方法，但随着时间的推移，其使用量逐渐减少。血管内治疗技术的传播似乎已广泛应用于患者和医院亚组。
