Li Wenqiang, Zhu Wei, Sun Xinguo, Liu Jian, Wang Yang, Wang Kun, Zhang Ying, Yang Xinjian, Zhang Yisen
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Jun 3;12:625652. doi: 10.3389/fneur.2021.625652. eCollection 2021.
Flow diverters and conventional coiling are established modalities for the retreatment of intracranial recurrent aneurysms after initial endovascular treatment. We aimed to compare the efficacy of these techniques. We retrospectively analyzed data for patients with recurrent aneurysms after initial endovascular treatment retreated in our center with either a pipeline embolization device (PED) or conventional coil embolization from January 2012 to July 2020. We performed 1:2 propensity score matching (PSM) using the nearest neighbor method. We controlled for: initial treatment strategy, aneurysm size, neck diameter, symptom presentation, history of aneurysm rupture, age, sex, fusiform-dissecting aneurysm, bifurcation aneurysm, and aneurysm location. The clinical and morphological factors of all patients at initial treatment and the angiographic and clinical results at the second treatment were collected and compared between the propensity-matched pairs. A total of 105 intracranial aneurysms were identified; 18 patients (17.1%) were treated with a PED, and 87 (82.9%) were treated via conventional coil embolization. PSM resulted in 12 matched pairs (12 patients in the PED group and 24 in the coiling group). There was no significant difference of ischemic and hemorrhagic complications between the groups, the obliteration rate of branches covered by stent, or modified Rankin Scale scores at the last clinical follow-up. Importantly, the retreatment strategy in the PED group provided significantly different results vs. the coiling group ( < 0.001), with a lower recurrence rate (0.0 vs. 29.2%, respectively; = 0.037). However, the procedural failure rate and the parent artery stenosis were more frequently in PED group compared with coiling group (both were 16.7 vs. 0.0%; = 0.040). Endovascular retreatment for recurrent aneurysms after initial endovascular treatment might be safe and effective. Flow diverters might be associated with reduced risk of recanalization and an increased risk of procedural failure and mild parent artery stenosis.
血流导向装置和传统弹簧圈栓塞是颅内初次血管内治疗后复发性动脉瘤再治疗的既定方式。我们旨在比较这些技术的疗效。我们回顾性分析了2012年1月至2020年7月在我们中心接受初次血管内治疗后复发性动脉瘤患者的数据，这些患者采用管道栓塞装置（PED）或传统弹簧圈栓塞进行再治疗。我们使用最近邻法进行1:2倾向评分匹配（PSM）。我们控制了以下因素：初次治疗策略、动脉瘤大小、颈部直径、症状表现、动脉瘤破裂史、年龄、性别、梭形 - 夹层动脉瘤、分叉动脉瘤和动脉瘤位置。收集所有患者初次治疗时的临床和形态学因素以及二次治疗时的血管造影和临床结果，并在倾向匹配对之间进行比较。共识别出105个颅内动脉瘤；18例患者（17.1%）接受了PED治疗，87例（82.9%）接受了传统弹簧圈栓塞治疗。PSM产生了12对匹配对（PED组12例患者，弹簧圈栓塞组24例患者）。两组之间在缺血性和出血性并发症、支架覆盖分支的闭塞率或最后一次临床随访时的改良Rankin量表评分方面没有显著差异。重要的是，PED组的再治疗策略与弹簧圈栓塞组相比结果有显著差异（<0.001），复发率较低（分别为0.0%和29.2%；=0.037）。然而，与弹簧圈栓塞组相比，PED组的手术失败率和载瘤动脉狭窄更常见（两者均为16.7%对0.0%；=0.040）。初次血管内治疗后复发性动脉瘤的血管内再治疗可能是安全有效的。血流导向装置可能与再通风险降低以及手术失败风险增加和轻度载瘤动脉狭窄有关。
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