三维动脉瘤体积测量结果显示，弹簧圈填充密度与复发之间无相关性。
Three-dimensional aneurysm volume measurements show no correlation between coil packing density and recurrence.
作者信息
Thaci Bart, Nuño Miriam, Varshneya Kunal, Gerndt Clayton H, Kercher Matthew, Dahlin Brian C, Waldau Ben
机构信息
Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, USA.
Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, USA.
出版信息
Heliyon. 2020 Oct 8;6(10):e05170. doi: 10.1016/j.heliyon.2020.e05170. eCollection 2020 Oct.
OBJECTIVE
Endovascular treatment is the mainstay therapy for brain aneurysms. About 15% of patients need re-treatment within six months due to early recanalization. In this study, we investigate risk factors associated with treatment failure.
METHODS
This retrospective cohort study includes endovascularly treated aneurysm cases between July 2012 and December 2015 at the University of California Davis Medical Center with pre-treatment and early post-treatment imaging. Thin cut 3D aneurysm volume rendering was used for morphologic analyses. Univariate and bivariate analyses were conducted to evaluate differences between patients and clinical factors by treatment failure.
RESULTS
Of the 50 patients who met the inclusion criteria, 41 (82.0%) were female, with an average age of 61 years. Most aneurysms were on the anterior communicating artery (40%) or posterior communicating artery (22.0%), and 34 (68%) aneurysms were ruptured. Early treatment failure was observed in 14 (28.0%) of endovascularly treated patients. Raymond-Roy class (RRC) was significantly associated with treatment failure (p = 0.0052), with 10 out of the 14 cases (71.4%) with early recanalization having an RRC of 3. Coil packing density did not associate with aneurysm recanalization (p = 0.61).
CONCLUSION
In our single institution series, patient characteristics, aneurysm characteristics, or coil packing density did not affect early aneurysm recanalization. RRC was the best predictor of early recanalization; however, further confirmation with additional studies are required. Although this study focused on early treatment failure, late recanalization has been shown with longer follow up. Further investigation into factors associated with late treatment failure will need further investigation. New intrasaccular devices and flow diverters will also likely play a role in reducing recurrence in the future as these treatments gain usage.
目的
血管内治疗是脑动脉瘤的主要治疗方法。约15%的患者因早期再通需要在六个月内进行再次治疗。在本研究中，我们调查与治疗失败相关的危险因素。
方法
这项回顾性队列研究纳入了2012年7月至2015年12月在加利福尼亚大学戴维斯分校医学中心接受血管内治疗的动脉瘤病例，并进行了治疗前和治疗后早期的影像学检查。采用薄层3D动脉瘤容积重建进行形态学分析。进行单因素和双因素分析以评估患者与临床因素在治疗失败方面的差异。
结果
符合纳入标准的50例患者中，41例（82.0%）为女性，平均年龄61岁。大多数动脉瘤位于前交通动脉（40%）或后交通动脉（22.0%），34例（68%）动脉瘤破裂。血管内治疗的患者中有14例（28.0%）出现早期治疗失败。Raymond-Roy分级（RRC）与治疗失败显著相关（p = 0.0052），14例早期再通病例中有10例（71.4%）RRC为3级。弹簧圈填充密度与动脉瘤再通无关（p = 0.61）。
结论
在我们的单机构系列研究中，患者特征、动脉瘤特征或弹簧圈填充密度均不影响动脉瘤早期再通。RRC是早期再通的最佳预测指标；然而，需要更多研究进一步证实。尽管本研究关注早期治疗失败，但长期随访显示存在晚期再通情况。对与晚期治疗失败相关因素的进一步研究仍需开展。随着新型囊内装置和血流导向装置的应用增加，它们未来可能在降低复发率方面发挥作用。
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