急性破裂颅内动脉瘤血管内治疗后不完全闭塞的安全性和结局：一项病例对照研究。
The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study.
机构信息
Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China.
出版信息
BMC Neurol. 2020 Nov 11;20(1):412. doi: 10.1186/s12883-020-01991-y.
BACKGROUND
Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting. This study aimed to evaluate the safety and outcomes of those aneurysms after SAC and NSC; And to discover whether the stents can promote progressive aneurysm occlusion in such lesions or not.
METHODS
We reviewed 199 patients with acutely RIAs underwent endovascular coiling and developed incomplete occlusion in the past seven years. The patients' clinical and imaging information were recorded and analyzed. Univariate and multivariate analyses were performed to determine the association of recurrence rate with potential risk factors.
RESULTS
SAC group had wider aneurysms neck (3.471 mm vs 2.830 mm, P = 0.009) and smaller dome-to-neck ratio (1.536 vs 2.111, P = 0.001) than in NSC group. There was no significant difference between the two groups in total procedure-related complications rate (31.7% vs 23.5%, P = 0.195), procedure-related mortality (6.9% vs 2.0%, P = 0.170) and modified Rankin Scale (mRS) score at 6-month follow-up (P > 0.05). However, SAC group had significantly higher ischemic complications rate (21.8% vs 8.2%, P = 0.007) and complete occlusion rate (65.6% vs 48.3%, P = 0.020), and lower recurrence rate (15.6% vs 28.1%, P = 0.042) than NSC group based on 6-month follow-up angiograms. Additionally, Multivariable analysis showed NSC was an independent risk factor for aneurysm recurrence (Odds Ratio [OR]: 4.061; P = 0.018).
CONCLUSIONS
Acutely RIAs with incomplete occlusion after SAC is associated with higher complications rate and mortality, but has an acceptable safety profile and similar clinical outcome compared to NSC, as well as gives patients superior angiography outcome by progressive occlusion of stents.
背景
即刻治疗后血管造影显示不完全动脉瘤闭塞是常见特征。支架辅助弹簧圈栓塞（SAC）和无支架弹簧圈栓塞（NSC）后急性破裂颅内动脉瘤（RIA）不完全闭塞的安全性和结局尚未明确。支架的渐进性闭塞可以促进颅内动脉瘤（IA）的完全闭塞，但尚未确定在 coil 后不完全闭塞的急性 RIA 中，支架的渐进性闭塞是否可以通过保护性支架来增强。本研究旨在评估 SAC 和 NSC 后这些动脉瘤的安全性和结局；并发现支架是否可以促进此类病变中动脉瘤的渐进性闭塞。
方法
我们回顾了过去七年中 199 例接受急性 RIA 血管内 coil 并出现不完全闭塞的患者的临床和影像学资料。记录并分析了患者的临床和影像学资料。采用单因素和多因素分析来确定复发率与潜在危险因素的相关性。
结果
SAC 组的动脉瘤颈更宽（3.471mm vs 2.830mm，P=0.009），瘤颈比更小（1.536 比 2.111，P=0.001）。两组总手术相关并发症发生率（31.7%比 23.5%，P=0.195）、手术相关死亡率（6.9%比 2.0%，P=0.170）和 6 个月随访时改良 Rankin 量表（mRS）评分（P＞0.05）无显著差异。然而，SAC 组缺血性并发症发生率（21.8%比 8.2%，P=0.007）和完全闭塞率（65.6%比 48.3%，P=0.020）较高，复发率（15.6%比 28.1%，P=0.042）较低。多变量分析显示，NSC 是动脉瘤复发的独立危险因素（优势比[OR]：4.061；P=0.018）。
结论
急性破裂颅内动脉瘤 coil 后不完全闭塞与更高的并发症发生率和死亡率相关，但与 NSC 相比，安全性和临床结局可接受，支架渐进性闭塞为患者提供了更好的血管造影结果。
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