《Woven EndoBridge 装置治疗后血管造影动脉瘤闭塞的预测因素：一项中期随访的单中心经验》
Predicting Factors of Angiographic Aneurysm Occlusion after Treatment with the Woven EndoBridge Device: A Single-Center Experience with Midterm Follow-Up.
机构信息
From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
出版信息
AJNR Am J Neuroradiol. 2019 Oct;40(10):1773-1778. doi: 10.3174/ajnr.A6221. Epub 2019 Sep 19.
BACKGROUND AND PURPOSE
Flow disruption with the Woven EndoBridge is increasingly used for the treatment of intracranial aneurysms. We examined factors leading to aneurysm occlusion and Woven EndoBridge shape change during a midterm follow-up.
MATERIALS AND METHODS
Patients with a minimum 12-month angiographic follow-up were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (Raymond-Roy 1/Raymond-Roy 2) and Woven EndoBridge shape change (decrease of the height of the device) were assessed.
RESULTS
Eighty-six patients/aneurysms were included. The aneurysm mean size was 5.5 mm (range, 3-11.5 mm). The most common locations were the MCA (43/86 = 50%), basilar tip (13/86 = 15.1%), and anterior communicating artery (12/86 = 14%). Twenty-one patients (21/86 = 24%) had acute SAH. Immediate and long-term Raymond-Roy 1/Raymond-Roy 2 occlusion rates were 49% (42/86) and 80% (68/86), respectively. Woven EndoBridge shape change was detected among 22% (19/86) of cases. At binary logistic regression, wide ostium (≥4 mm) (OR = 0.2; 95% CI, 0.01-1; = .04) and regular aneurysm morphology (OR = 5.9; 95% CI, 1.4-24; = .01) were independent factors of incomplete and adequate aneurysm occlusion, respectively. In addition, irregular morphology (OR = 5.4; 95%CI, 1.4-19; = .01) and a wide ostium (OR = 9.8; 95% CI, 1.6-60; = .03) significantly increased the probability of the Woven EndoBridge shape change. Decrease of the Woven EndoBridge height was more common among incompletely occluded aneurysms (6/12 = 50% versus 13/74 = 17.5%), but it was not an independent prognosticator of occlusion at the multivariate model.
CONCLUSIONS
The likelihood of good occlusion was 5 times lower in the presence of a wide ostium, whereas aneurysms with regular morphology were 6 times more likely to be occluded. Woven EndoBridge shape modification was strongly influenced by the aneurysm shape and ostium size, and it was not independently associated with the angiographic occlusion.
背景与目的
编织型 EndoBridge 的血流阻断技术越来越多地用于颅内动脉瘤的治疗。我们在中期随访中研究了导致动脉瘤闭塞和编织型 EndoBridge 形态改变的因素。
材料与方法
纳入了至少进行 12 个月血管造影随访的患者。通过单变量和多变量分析，评估了达到充分闭塞（Raymond-Roy 1/Raymond-Roy 2）和编织型 EndoBridge 形态改变（设备高度降低）的独立预测因素。
结果
共纳入 86 例患者/动脉瘤。动脉瘤的平均大小为 5.5 毫米（范围 3-11.5 毫米）。最常见的部位是 MCA（43/86 = 50%）、基底动脉尖（13/86 = 15.1%）和前交通动脉（12/86 = 14%）。21 例患者（21/86 = 24%）有急性蛛网膜下腔出血。即刻和长期的 Raymond-Roy 1/Raymond-Roy 2 闭塞率分别为 49%（42/86）和 80%（68/86）。22%（19/86）的病例出现编织型 EndoBridge 形态改变。在二元逻辑回归中，宽口（≥4 毫米）（OR = 0.2；95%CI，0.01-1； =.04）和规则的动脉瘤形态（OR = 5.9；95%CI，1.4-24； =.01）分别是不完全和充分动脉瘤闭塞的独立因素。此外，不规则形态（OR = 5.4；95%CI，1.4-19； =.01）和宽口（OR = 9.8；95%CI，1.6-60； =.03）显著增加了编织型 EndoBridge 形态改变的概率。未完全闭塞的动脉瘤中，编织型 EndoBridge 高度降低更为常见（6/12 = 50%比 13/74 = 17.5%），但在多变量模型中，它不是闭塞的独立预后因素。
结论
存在宽口时，良好闭塞的可能性降低 5 倍，而形态规则的动脉瘤闭塞的可能性增加 6 倍。编织型 EndoBridge 形态改变受动脉瘤形态和口部大小的强烈影响，与血管造影闭塞无独立关系。
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