From the Departments of Neuroradiology, Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, 45 Rue Cognacq-Jay, 51092 Reims, France (L.P., H.A.N., S.S., M.G.); Department of Research and Public Health, Hôpital Robert Debré, CHU Reims, Reims, France (C.B.); CHU Tours, Tours, France (D.H.); CHU Rennes, Rennes, France (J.Y.G.); CHU Toulouse, Toulouse, France (A.C.J.); CHU Lille, Lille, France (F.B.); CHU Dijon, Dijon France (P.O.C.); CHU Nantes, Nantes, France (H.D.); CHU Poitiers, Poitiers, France (S.V.); CHU Saint-Etienne, Saint-Etienne, France (M.A.); CHU Clermont-Ferrand, Clermont-Ferrand, France (E.C.); CHU Nice, Nice, France (J.S.); Centre Hospitalier Sainte-Anne, Paris, France (D.T.); CHU Bordeaux, Bordeaux, France (G.M.); CHU Créteil, Créteil, France (S.G.); Hôpital Foch, Suresnes, France (G.R.); CHU Pitié-Salpêtrière, Paris, France (F.C.); Interventional Neuroradiology, NEURI Center, Hopital Bicêtre, Le Kremlin-Bicêtre, France (L.S.); Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom (P.W.).
Radiology. 2020 May;295(2):381-389. doi: 10.1148/radiol.2020191842. Epub 2020 Feb 25.
Background Thromboembolic events and intraoperative rupture are the most frequent neurologic complications of intracranial aneurysm coiling. Their frequency has not been evaluated in recent series. Purpose To provide an analysis of complications, clinical outcome, and participant and aneurysm risk factors after aneurysm coiling or balloon-assisted coiling within the Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm, or ARETA, cohort. Materials and Methods Sixteen neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms between December 2013 and May 2015. Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. Data were analyzed from participants within the overall cohort treated with coiling or balloon-assisted coiling for a single aneurysm. Rates of neurologic complications were analyzed, and associated factors were studied by using univariable analyses (Student test, χ test, or Fisher exact test, as appropriate) and multivariable analyses (logistic regressions). Results A total of 1088 participants (mean age ± standard deviation, 54 years ± 13; 715 women [65.7%]) were analyzed. Thromboembolic events and intraoperative rupture were reported in 113 of 1088 participants (10.4%) and 34 of 1088 participants (3.1%), respectively. Poor clinical outcome (defined as modified Rankin Scale score of 3-6) was reported in 29 of 113 participants (25.7%) with thromboembolic events and in 11 of 34 participants (32.4%) with intraoperative rupture ( = .44). Factors associated with thromboembolic events were female sex (odds ratio [OR], 1.7; 95% confidence interval [CI]: 1.1, 2.8; = .02) and middle cerebral artery location (OR, 1.9; 95% CI: 1.2, 3.0; = .008). Factors associated with intraoperative rupture were anterior communicating artery location (OR, 2.2; 95% CI: 1.1, 4.7; = .03) and small aneurysm size (OR, 3.0; 95% CI: 1.5, 6.3; = .003). Conclusion During aneurysm coiling or balloon-assisted coiling, thromboembolic events were more frequent than were intraoperative rupture. Both complications were associated with poor clinical outcome in a similar percentage of participants. Risk factors for thromboembolic events were female sex and middle cerebral artery location. Risk factors for intraoperative rupture were small aneurysm size and anterior cerebral or communicating artery location. © RSNA, 2020.
背景 颅内动脉瘤血管内治疗中最常见的神经并发症是血栓栓塞事件和术中破裂。最近的系列研究并未评估其发生频率。目的 分析在颅内动脉瘤血管内治疗后再通分析（ARETA）队列中，接受颅内动脉瘤弹簧圈栓塞或球囊辅助弹簧圈栓塞治疗的患者的并发症、临床转归以及患者和动脉瘤的危险因素。材料与方法 16 个神经介入治疗部门前瞻性地纳入了 2013 年 12 月至 2015 年 5 月期间接受治疗的破裂和未破裂动脉瘤患者。记录患者的人口统计学、动脉瘤特征和血管内技术。对接受单个动脉瘤弹簧圈栓塞或球囊辅助弹簧圈栓塞治疗的总体队列中的患者进行神经并发症发生率的分析，并通过单变量分析（学生 t 检验、卡方检验或 Fisher 确切概率检验，视具体情况而定）和多变量分析（逻辑回归）研究相关因素。结果 共分析了 1088 例患者（平均年龄±标准差，54 岁±13 岁；715 例女性[65.7%]）。1088 例患者中有 113 例（10.4%）和 34 例（3.1%）分别发生血栓栓塞事件和术中破裂。113 例发生血栓栓塞事件的患者中有 29 例（25.7%）和 34 例发生术中破裂的患者中有 11 例（32.4%）报告预后不良（定义为改良 Rankin 量表评分 3-6 分）（ =.44）。与血栓栓塞事件相关的因素是女性（比值比[OR]，1.7；95%置信区间[CI]：1.1，2.8； =.02）和大脑中动脉部位（OR，1.9；95% CI：1.2，3.0； =.008）。与术中破裂相关的因素是前交通动脉部位（OR，2.2；95% CI：1.1，4.7； =.03）和较小的动脉瘤大小（OR，3.0；95% CI：1.5，6.3； =.003）。结论 在颅内动脉瘤弹簧圈栓塞或球囊辅助弹簧圈栓塞过程中，血栓栓塞事件比术中破裂更常见。这两种并发症在相似比例的患者中都与较差的临床转归相关。血栓栓塞事件的危险因素是女性和大脑中动脉部位。术中破裂的危险因素是较小的动脉瘤大小和前交通或前循环动脉部位。 ©RSNA，2020.
