Xue Gaici, Zuo Qiao, Zhang Xiaoxi, Tang Haishuang, Zhao Rui, Li Qiang, Fang Yibin, Yang Pengfei, Hong Bo, Xu Yi, Huang Qinghai, Liu Jianmin
Department of Neurosurgery, General Hospital of Southern Theatre Command of PLA, 111 Liuhua Road, Guangzhou, 510010, China.
Department of Neurosurgery, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
Chin Neurosurg J. 2021 Mar 3;7(1):19. doi: 10.1186/s41016-021-00237-1.
To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms.
Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling (LVIS stent group) and laser-cut stent-assisted coiling (laser-cut stent group) were retrospectively reviewed from January 2014 to December 2017. Propensity score matching was used to adjust for potential differences in age, sex, aneurysm location, aneurysm size, neck width, Hunt-Hess grade, and modified Fisher grade. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors.
A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching. The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group (92.7% vs 80.6%; 3.7% vs 9.7%, P = 0.078). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.495 and P = 0.875, respectively). The rates of intraprocedural thrombosis, postprocedural thrombosis, postoperative early rebleeding, and procedure-related death were 0.7% (1/142), 1.4% (2/142), 2.8% (4/142), and 2.1% (3/142) in the LVIS stent group, respectively, and 4.3% (4/93), 2.2% (2/93), 1.1% (1/93), and 3.2% (3/93) in the laser-cut stent group, respectively (P = 0.082, 0.649, 0.651, and 0.683). Nevertheless, the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group (5.6% vs 14.0%, P = 0.028; 0.7% vs 6.5%, P = 0.016). Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedure-related complications (OR = 2.727, P = 0.037); a history of diabetes (OR = 7.275, P = 0.027) and other cerebrovascular diseases (OR = 8.083, P = 0.022) were independent predictors for ischemic complications, whereas none of the factors were predictors for hemorrhagic complications.
Compared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.
比较LVIS支架辅助弹簧圈栓塞术与激光切割支架辅助弹簧圈栓塞术治疗急性破裂宽颈颅内动脉瘤的安全性和有效性。
回顾性分析2014年1月至2017年12月期间接受LVIS支架辅助弹簧圈栓塞术（LVIS支架组）和激光切割支架辅助弹簧圈栓塞术（激光切割支架组）治疗的急性破裂宽颈颅内动脉瘤患者。采用倾向评分匹配法调整年龄、性别、动脉瘤位置、动脉瘤大小、颈宽、Hunt-Hess分级和改良Fisher分级的潜在差异。比较围手术期与手术相关的并发症以及临床和血管造影随访结果。进行单因素和多因素分析以确定与手术相关并发症和潜在危险因素之间的关联。
经过1:2倾向评分匹配后，共纳入142例行LVIS支架辅助弹簧圈栓塞术的患者和93例行激光切割支架辅助弹簧圈栓塞术的患者。血管造影随访结果显示，LVIS支架组的完全闭塞率略高于激光切割支架组，复发率低于激光切割支架组（92.7%对80.6%；3.7%对9.7%，P = 0.078）。两组出院时和随访时的临床结果无显著差异（分别为P = 0.495和P = 0.875）。LVIS支架组术中血栓形成、术后血栓形成、术后早期再出血和与手术相关的死亡率分别为0.7%（1/142）、1.4%（2/142）、2.8%（4/142）和2.1%（3/142），激光切割支架组分别为4.3%（4/93）、2.2%（2/93）、1.1%（1/93）和3.2%（3/93）（P = 0.082、0.649、0.651和0.683）。然而，LVIS支架组与手术相关的总体并发症发生率和术中破裂率显著低于激光切割支架组（5.6%对14.0%，P = 0.028；）。多因素分析显示，激光切割支架辅助弹簧圈栓塞术是与手术相关总体并发症的独立预测因素（OR = 2.727，P = 0.037）；糖尿病史（OR = 7.275，P = 0.027）和其他脑血管疾病史（OR = 8.）。
与激光切割支架辅助弹簧圈栓塞术相比，LVIS支架辅助弹簧圈栓塞术治疗急性破裂宽颈颅内动脉瘤可降低与手术相关的总体并发症发生率和术中破裂率。
