Zhang Yupeng, Liang Fei, Zhang Yuxiang, Yan Peng, Liang Shikai, Ma Chao, Jiang Chuhan
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
Front Neurol. 2019 Mar 26;10:275. doi: 10.3389/fneur.2019.00275. eCollection 2019.
The pipeline embolization device (PED) has been used to treat non-saccular, unruptured, intradural vertebral artery aneurysms at some institutions. However, there is an absence of large controlled studies validating the feasibility of this treatment. This study aimed to explore the therapeutic feasibility of PED by comparing PED treatment with controlled stent-assisted coiling (SAC). Thirty-two PED procedures were matched in a 1:2 manner with 64 SAC procedures based on patient age, sex, aneurysm size, and aneurysm location. Technical factors, procedural complications, angiographic results, and clinical outcomes were analyzed and compared. There was no statistically significant difference in technical factors and procedural complications between the two groups (PED vs. SAC, 9.4 vs. 4.7%, = 0.397). In multivariate analysis, smoking and therapeutic modality were identified as independent predictors of occlusion. Smoking was a risk factor for aneurysm obliteration [hazard ratio (HR) 0.53; 95% confidence interval (CI), 0.31-0.89; = 0.018]. Aneurysms treated with PED were more likely to achieve obliteration over time compared with aneurysms treated with SAC (HR 2.97; 95% CI, 1.79-4.93; < 0.001). The rate of favorable clinical outcomes (modified Rankin Scale (mRS), 0-2) was similar between the two groups (PED vs. SAC, 100 vs. 96.9%, = 0.551). In the SAC group, one patient had neurological deficit with an mRS of four at the latest follow-up. There was no mortality in either group. The PED and SAC groups showed similar technical factors, procedural complications, angiographic results, and favorable clinical outcomes. Aneurysms treated with PED were more prone to obliteration over time than aneurysms treated with SAC. These outcomes suggest, based on short-term follow-up, PED is a safe and feasible strategy for the treatment of non-saccular, unruptured, intradural vertebral artery aneurysms.
在一些机构中，管道栓塞装置（PED）已被用于治疗非囊状、未破裂的硬脊膜内椎动脉动脉瘤。然而，目前缺乏大型对照研究来验证这种治疗方法的可行性。本研究旨在通过将PED治疗与对照性支架辅助弹簧圈栓塞术（SAC）进行比较，探讨PED的治疗可行性。根据患者年龄、性别、动脉瘤大小和动脉瘤位置，以1:2的方式将32例PED手术与64例SAC手术进行匹配。对技术因素、手术并发症、血管造影结果和临床结局进行了分析和比较。两组之间的技术因素和手术并发症无统计学显著差异（PED组与SAC组，分别为9.4%和4.7%，P = 0.397）。在多变量分析中，吸烟和治疗方式被确定为闭塞的独立预测因素。吸烟是动脉瘤闭塞的危险因素[风险比（HR）0.53；95%置信区间（CI），0.31 - 0.89；P = 0.018]。与接受SAC治疗的动脉瘤相比，接受PED治疗的动脉瘤随着时间推移更有可能实现闭塞（HR 2.97；95% CI，1.79 - 4.93；P < 0.001）。两组之间良好临床结局（改良Rankin量表（mRS），0 - 2）的发生率相似（PED组与SAC组，分别为100%和96.9%，P = 0.551）。在SAC组中，1例患者在最近一次随访时出现神经功能缺损，mRS为4。两组均无死亡病例。PED组和SAC组在技术因素、手术并发症、血管造影结果和良好临床结局方面表现相似。与接受SAC治疗的动脉瘤相比，接受PED治疗的动脉瘤随着时间推移更容易闭塞。基于短期随访，这些结果表明，PED是治疗非囊状、未破裂的硬脊膜内椎动脉动脉瘤的一种安全可行的策略。
