1189 例颅内动脉瘤血管内治疗（弹簧圈或球囊辅助弹簧圈）后即刻动脉瘤闭塞的前瞻性多中心队列研究：颅内动脉瘤血管内治疗后再通分析（ARETA 研究）。
Immediate post-operative aneurysm occlusion after endovascular treatment of intracranial aneurysms with coiling or balloon-assisted coiling in a prospective multicenter cohort of 1189 patients: Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) Study.
机构信息
Neuroradiology, CHU Reims, Reims, Champagne-Ardenne, France
Department of Research and Public Health, Centre Hospitalier Universitaire de Reims, Reims, Champagne-Ardenne, France.
出版信息
J Neurointerv Surg. 2021 Oct;13(10):918-923. doi: 10.1136/neurintsurg-2020-017012. Epub 2020 Dec 21.
BACKGROUND
Coiling, including balloon-assisted coiling (BAC), is the first-line therapy for ruptured and unruptured aneurysms. Its efficacy can be clinically evaluated by bleeding/rebleeding rate after coiling, and anatomically evaluated by aneurysm occlusion post-procedure and during follow-up. We aimed to analyze immediate post-coiling aneurysm occlusion and associated factors within the Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) population.
METHODS
Between December 2013 and May 2015, 16 neurointerventional departments prospectively enrolled participants treated for ruptured and unruptured aneurysms (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics, and endovascular techniques were recorded. In patients with aneurysms treated by coiling or BAC, immediate post-operative aneurysm occlusion was independently evaluated by a core lab using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant.
RESULTS
Of 1135 participants (age 53.8±12.8 years, 754 women (66.4%)), 1189 aneurysms were analyzed. Treatment modality was standard coiling in 645/1189 aneurysms (54.2%) and BAC in 544/1189 (45.8%). Immediate post-operative aneurysm occlusion was complete occlusion in 57.8%, neck remnant in 34.4%, and aneurysm remnant in 7.8%. Adequate occlusion (complete occlusion or neck remnant) was significantly more frequent in aneurysms with size <10 mm (93.1% vs 86.3%; OR 1.8, 95% CI 1.1 to 3.2; p=0.02) and in aneurysms with a narrow neck (95.8% vs 89.6%; OR 2.5, 95% CI 1.5 to 4.1; p=0.0004). Patients aged <70 years had significantly more adequate occlusion (92.7% vs 87.2%; OR 1.9, 95% CI 1.1 to 3.4; p=0.04).
CONCLUSIONS
Immediately after aneurysm coiling, including BAC, adequate aneurysm occlusion was obtained in 92.2%. Age <70 years, aneurysm size <10 mm, and narrow neck were factors associated with adequate occlusion.
TRIAL REGISTRATION NUMBER
NCT01942512, http://www.clinicaltrials.gov.
背景
弹簧圈栓塞术（包括球囊辅助弹簧圈栓塞术[BAC]）是破裂和未破裂动脉瘤的一线治疗方法。其疗效可以通过弹簧圈栓塞后的出血/再出血率进行临床评估，也可以通过术后和随访期间的动脉瘤闭塞情况进行解剖学评估。我们旨在分析血管内治疗颅内动脉瘤后再通分析（ARETA）人群中弹簧圈栓塞后即刻的动脉瘤闭塞情况及其相关因素。
方法
2013 年 12 月至 2015 年 5 月，16 个神经介入科前瞻性纳入了接受破裂和未破裂动脉瘤治疗的参与者（ClinicalTrials.gov：NCT01942512）。记录参与者的人口统计学、动脉瘤特征和血管内技术。在接受弹簧圈或 BAC 治疗的动脉瘤患者中，通过核心实验室使用 3 级量表独立评估术后即刻的动脉瘤闭塞情况：完全闭塞、瘤颈残留和动脉瘤残留。
结果
在 1135 名参与者（年龄 53.8±12.8 岁，754 名女性[66.4%]）中，共分析了 1189 个动脉瘤。1189 个动脉瘤中，标准弹簧圈治疗 645 个（54.2%），BAC 治疗 544 个（45.8%）。术后即刻动脉瘤闭塞完全闭塞 57.8%，瘤颈残留 34.4%，动脉瘤残留 7.8%。瘤颈<10mm 的动脉瘤和瘤颈较窄的动脉瘤完全闭塞或瘤颈残留的比例明显更高（93.1%比 86.3%；OR 1.8，95%CI 1.1 至 3.2；p=0.02）（95.8%比 89.6%；OR 2.5，95%CI 1.5 至 4.1；p=0.0004）。<70 岁的患者完全闭塞的比例明显更高（92.7%比 87.2%；OR 1.9，95%CI 1.1 至 3.4；p=0.04）。
结论
包括 BAC 在内的动脉瘤弹簧圈栓塞术后即刻，动脉瘤闭塞良好的比例为 92.2%。<70 岁、瘤颈<10mm、瘤颈较窄是与良好闭塞相关的因素。
试验注册
NCT01942512，http://www.clinicaltrials.gov。
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