Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
Stroke Vasc Neurol. 2021 Sep;6(3):366-375. doi: 10.1136/svn-2020-000413. Epub 2021 Feb 1.
With widely usage of flow diverter in intracranial aneurysm treatment, some previously used predictors may not be effective in evaluating the recurrence risk. We aimed to comprehensively re-evaluate the predictors of intracranial aneurysm outcome with various endovascular treatment methods and devices.
This is a prospective registered study. We analysed 6-month and 18-month follow-up angiographic data from the prospective study. Data on patient demographics, aneurysm morphology and type of treatment were recorded. Patient-specific haemodynamic simulations were performed. An unfavourable angiographic outcome was defined as recurrence of aneurysm in cases with coiling or stent-assisted coiling, patency of aneurysm in cases with flow diverters or retreatment during follow-up.
In total, 165 patients (177 intracranial aneurysms) with at least one angiographic follow-up data were analysed. For the short-term (6-month) results, after univariate analysis, the demographic, morphological and treatment-related factors did not achieve significantly statistical differences. The reduction ratio (RR) of velocity at aneurysm neck after embolisation was significantly lower in the unfavourable angiographic group than the favourable angiographic outcome group (p=0.002). After the Cox regression analysis, the RR of velocity at aneurysm neck was the only independent factor associated with favourable angiographic outcome (OR 0.028; p=0.001) and had an acceptable area under the curve (0.714) with a clear cut-off value (46.14%). Similarly, for the analysis of midterm (18-month) results, the RR of velocity at the aneurysm neck was the only independent significant factor for the unfavourable angiographic outcome (OR 0.050; p=0.017). The area under the curve was 0.754 and the cut-off value was 48.20%.
The haemodynamics showed an independent effect on angiographic follow-up results and may provide helpful suggestions for clinical practice in the future.
随着血流导向装置在颅内动脉瘤治疗中的广泛应用，一些以前使用的预测因子可能无法有效评估复发风险。我们旨在综合评估各种血管内治疗方法和装置的颅内动脉瘤治疗结果的预测因子。
这是一项前瞻性注册研究。我们分析了前瞻性研究的 6 个月和 18 个月的血管造影随访数据。记录患者人口统计学、动脉瘤形态和治疗类型的数据。进行了患者特异性血流动力学模拟。将动脉瘤复发、血流导向装置治疗后动脉瘤仍通畅或随访期间再次治疗定义为不良血管造影结果。
总共分析了 165 例（177 个颅内动脉瘤）至少有一次血管造影随访数据的患者。对于短期（6 个月）结果，单因素分析后，人口统计学、形态学和治疗相关因素未达到显著统计学差异。栓塞后瘤颈处速度的降低率（RR）在不良血管造影组显著低于良好血管造影组（p=0.002）。在 Cox 回归分析后，瘤颈处速度的 RR 是与良好血管造影结果相关的唯一独立因素（OR 0.028；p=0.001），并且具有可接受的曲线下面积（0.714），具有明确的截止值（46.14%）。同样，对于中期（18 个月）结果的分析，瘤颈处速度的 RR 是不良血管造影结果的唯一独立显著因素（OR 0.050；p=0.017）。曲线下面积为 0.754，截止值为 48.20%。
血流动力学对血管造影随访结果具有独立影响，未来可能为临床实践提供有价值的建议。
