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. 2019 May;125:e385-e391. doi: 10.1016/j.wneu.2019.01.082. Epub 2019 Jan 28.
To analyze and compare safety and efficacy of different endovascular treatment modalities for unruptured intracranial large or giant aneurysms.
We retrospectively reviewed 126 consecutive patients with 128 large (15-24 mm) or giant (≥25 mm) aneurysms that were treated with different endovascular procedures between January 2014 and February 2017. We compared clinical and angiographic outcomes and occurrence of technical events among 3 treatment modalities.
Complete occlusion at last follow-up was achieved in 65.6%, 90.5%, and 72.0% of aneurysms in stent-assisted coiling, parent artery occlusion, and Pipeline embolization device (PED) groups (P = 0.119). Complete occlusion rate at 6-month follow-up (odds ratio = 1.81, P = 0.396) and at last angiographic follow-up (odds ratio = 3.64, P = 0.123), was not superior with parent artery occlusion compared with PED. Retreatment rate was significantly different among all groups (P < 0.001); the rate was highest in the stent-assisted coiling group (21.9%). Rates of hemorrhagic events and ischemic events were not significantly different among groups (P = 0.581). Mass effect exacerbation was more frequently seen in the stent-assisted coiling group (24.4% vs. 7.7% and 3.3%, P = 0.004). Major complication rate was higher in the parent artery occlusion group compared with the PED group, but the difference was not statistically significant (19.2% vs. 16.4%, odds ratio = 1.21, P = 0.763). Rate of technical events was significantly different in the 3 groups (P = 0.0437), and technical events occurred more often in the PED group (18.0%).
For large and giant aneurysms located in the internal carotid artery, outcome for endovascular treatment remains poor, even with the introduction of PED.
分析比较不同血管内治疗方式治疗未破裂颅内大型或巨大动脉瘤的安全性和疗效。
我们回顾性分析了 2014 年 1 月至 2017 年 2 月期间，采用不同血管内治疗方法治疗的 126 例连续患者的 128 个大型（15-24mm）或巨大（≥25mm）动脉瘤。我们比较了 3 种治疗方式的临床和血管造影结果以及技术事件的发生情况。
支架辅助弹簧圈组、载瘤动脉闭塞组和 Pipeline 栓塞装置（PED）组的动脉瘤完全闭塞率分别为 65.6%、90.5%和 72.0%（P=0.119）。6 个月随访时的完全闭塞率（比值比=1.81，P=0.396）和末次血管造影随访时的完全闭塞率（比值比=3.64，P=0.123）与 PED 相比，载瘤动脉闭塞并无优势。所有组之间的再治疗率均有显著差异（P<0.001）；支架辅助弹簧圈组最高（21.9%）。各组出血事件和缺血事件发生率无显著差异（P=0.581）。支架辅助弹簧圈组的占位效应加重更为常见（24.4%比 7.7%和 3.3%，P=0.004）。载瘤动脉闭塞组的主要并发症发生率高于 PED 组，但差异无统计学意义（19.2%比 16.4%，比值比=1.21，P=0.763）。3 组之间的技术事件发生率有显著差异（P=0.0437），PED 组的技术事件更为常见（18.0%）。
对于位于颈内动脉的大型和巨大动脉瘤，即使采用 Pipeline 栓塞装置，血管内治疗的结局仍然不佳。
