Fang Yibin, Zhu Deyuan, Peng Ya, Zhong Ming, Xu Jing, Li Qiuping, Liang Guobiao, Wang Yang, Feng Wenfeng, Wang Donghai, Zhang Yang, Chen Dong, Guo Qingdong, Li Tianxiao, Xie Xiaodong, Zhu Gang, Guan Sheng, Gu Zhen, Li Gang, Yang Hua, He Xueyang, Zhu Qin, Wan Jieqing, Li Qiang, Yang Pengfei, Zhao Rui, Huang Qianghai, Hong Bo, Xu Yi, Liu Jianmin
Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China.
Department of Neurosurgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China; Department of Neurosurgery, The 71st Group Army Hospital of CPLA Army (Affiliated Huaihai Hospital of Xuzhou Medical University), Xuzhou, China.
World Neurosurg. 2019 Jun;126:e486-e491. doi: 10.1016/j.wneu.2019.02.076. Epub 2019 Feb 27.
To clarify safety and efficacy of stent-assisted coiling for treatment of blood blister-like aneurysm (BBA) in a multicenter experience.
A total of 212 consecutive cases (213 BBAs) treated with stent-assisted coiling were retrospectively reviewed and included in the final analysis. Outcomes including complete occlusion, recurrence, perioperative morbidity and mortality, and overall good neurologic outcome during follow-up were analyzed.
Of 212 patients, 102 (48.1%) were treated with a single stent, 77 (36.3%) were treated with 2 stents, and 33 (15.6%) were treated with ≥3 stents. Angiographic follow-up data were available for 96 BBAs; 64.6% of BBAs showed complete obliteration, and 22.9% showed recurrence. Complete obliteration rates of patients treated with single, 2, and ≥3 stents were 42.9%, 78.4%, and 88.2%. Recurrence rates of patients treated with single, 2, and ≥3 stents were 38.1%, 13.5%, and 5.9%. Using ≥2 stents seemed to result in higher obliteration rates (P < 0.001) and lower recurrence rates (P = 0.002). Clinical follow-up data available for 180 patients showed 91.1% of patients had a good clinical outcome. No difference was found between the 3 stent treatments. There were 14 (6.6%) perioperative ischemic complications and 12 (5.7%) hemorrhagic complications, with 10 (4.7%) cases of perioperative deaths. Using ≥2 stents seemed to result in a lower perioperative hemorrhagic complication rate compared with single stent (P = 0.037).
Our data support the use of overlapping (≥2) stents combined with coiling as a safe and effective therapeutic modality for BBA. Overlapping (≥2) stents may provide higher obliteration rate, lower recurrence rate, and lower perioperative hemorrhagic risk in treatment of BBA.
在多中心经验中阐明支架辅助弹簧圈栓塞术治疗血泡样动脉瘤（BBA）的安全性和有效性。
回顾性分析连续212例接受支架辅助弹簧圈栓塞术治疗的病例（213个BBA）并纳入最终分析。分析结果包括完全闭塞、复发、围手术期发病率和死亡率以及随访期间的总体良好神经功能结局。
212例患者中，102例（48.1%）接受单个支架治疗，77例（36.3%）接受2个支架治疗，33例（15.6%）接受≥3个支架治疗。96个BBA有血管造影随访数据；64.6%的BBA显示完全闭塞，22.9%显示复发。接受单个、2个和≥3个支架治疗的患者的完全闭塞率分别为42.9%、78.4%和88.2%。接受单个、2个和≥3个支架治疗的患者的复发率分别为38.1%、13.5%和5.9%。使用≥2个支架似乎导致更高的闭塞率（P < 0.001）和更低的复发率（P = 0.002）。180例患者的临床随访数据显示91.1%的患者临床结局良好。三种支架治疗之间未发现差异。有14例（6.6%）围手术期缺血性并发症和12例（5.7%）出血性并发症，其中10例（4.7%）围手术期死亡。与单个支架相比，使用≥2个支架似乎导致围手术期出血性并发症发生率更低（P = 0.037）。
我们的数据支持使用重叠（≥2个）支架联合弹簧圈栓塞术作为治疗BBA的一种安全有效的治疗方式。重叠（≥2个）支架在治疗BBA时可能提供更高的闭塞率、更低的复发率和更低的围手术期出血风险。
