Vakharia Kunal, Waqas Muhammad, Shakir Hakeem J, Chin Felix, Hartke Joelle N, Shallwani Hussain, Beecher Jeffrey S, Siddiqui Adnan H, Levy Elad I
Department of Neurosurgery, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.
J Neurointerv Surg. 2020 Jun;12(6):585-590. doi: 10.1136/neurintsurg-2019-015610. Epub 2020 Jan 20.
A Pipeline embolization device (PED; Medtronic, Dublin, Ireland) can be deployed using either a biaxial or a triaxial catheter delivery system.
To compare the use of these two catheter delivery systems for intracranial aneurysm treatment with the PED.
A retrospective study of patients undergoing PED deployment with biaxial or triaxial catheter systems between 2014 and 2016 was conducted. Experienced neurointerventionalists performed the procedures. Patients who received multiple PEDs or adjunctive coils were excluded. The two groups were compared for PED deployment time, total fluoroscopy time, patient radiation exposure, complications, and cost.
Eighty-two patients with 89 intracranial aneurysms were treated with one PED each. In 49 cases, PEDs were deployed using biaxial access; triaxial access was used in 33 cases. Time (min) from guide catheter run to PED deployment was significantly shorter in the biaxial group (24.0±18.7 vs 38.4±31.1, P=0.006) as was fluoroscopy time (28.8±23.0 vs 50.3±27.1, P=0.001). Peak radiation skin exposure (mGy) in the biaxial group was less than in the triaxial group (1243.7±808.2 vs 2074.6±1505.6, P=0.003). No statistically significant differences were observed in transient and permanent complication rates or modified Rankin Scale scores at 30 days. The triaxial access system cost more than the biaxial access system (average $3285 vs $1790, respectively). Occlusion rates at last follow-up (mean 6 months) were similar between the two systems (average 88.1%: biaxial, 89.2%: triaxial).
Our results indicate near-equivalent safety and effectiveness between biaxial and triaxial approaches. Some reductions in cost and procedure time were noted with the biaxial system.
管道栓塞装置（PED；美敦力公司，爱尔兰都柏林）可通过双轴或三轴导管输送系统进行部署。
比较这两种导管输送系统在使用PED治疗颅内动脉瘤中的应用情况。
对2014年至2016年间使用双轴或三轴导管系统进行PED部署的患者进行回顾性研究。由经验丰富的神经介入专家实施手术。排除接受多个PED或辅助弹簧圈的患者。比较两组的PED部署时间、总透视时间、患者辐射暴露、并发症及费用。
82例患者共89个颅内动脉瘤，均接受了单个PED治疗。其中49例采用双轴入路部署PED；33例采用三轴入路。双轴组从导引导管到位至PED部署的时间（分钟）明显更短（24.0±18.7 vs 38.4±31.1，P = 0.006），透视时间也是如此（28.8±23.0 vs 50.3±27.1，P = 0.001）。双轴组的皮肤辐射峰值暴露（mGy）低于三轴组（1243.7±808.2 vs 2074.6±1505.6，P = 0.003）。在30天时，两组的短暂性和永久性并发症发生率或改良Rankin量表评分无统计学显著差异。三轴入路系统的成本高于双轴入路系统（分别为平均3285美元和1790美元）。两种系统在最后一次随访（平均6个月）时的闭塞率相似（双轴平均88.1%，三轴平均89.2%）。
我们的结果表明双轴和三轴方法在安全性和有效性方面近乎等效。双轴系统在成本和手术时间上有一定降低。
