Zhong Weiying, Kuang Hong, Zhang Ping, Yang Xinjian, Luo Bin, Maimaitili Aisha, Zhao Yuanli, Song Donglei, Guan Sheng, Zhang Hongqi, Wang Yang, Wang Donghai, Su Wandong, Wang Yunyan
Department of Neurosurgery, Institute of Brain and Brain-Inspired Science, Qilu Hospital of Shandong University, Shandong University, Jinan, China.
Shandong Key Laboratory of Brain Function Remodeling, Shandong University, Jinan, China.
Front Neurol. 2021 Sep 16;12:675917. doi: 10.3389/fneur.2021.675917. eCollection 2021.
The utilization of flow diversion for ruptured intracerebral aneurysms (IAs) is still limited. We aimed to demonstrate our multicenter experience using the pipeline embolization device (PED) for ruptured IAs that were difficult to treat by clipping and coiling. Thirty-eight patients with ruptured IAs who underwent PED treatment from 2015 to 2020 were retrospectively reviewed. Factors associated with procedure-related stroke (ischemic and hemorrhagic) and clinical and angiography outcomes were analyzed. There were 14 (36.8%) saccular IAs, 12 (31.6%) blister-like IAs, and 12 (31.6%) dissecting IAs. Perforator involvement was noted in 10 (26.3%) IAs. Early PED placement ( ≤ 15 days) and adjunctive coiling treatment were performed in 27 (71.1%) and 22 (57.9%) cases, respectively. The overall rate of stroke-related complications was 31.6% (12/38) (including rates of 10.5% for procedure-related hemorrhagic complications and 15.8% for procedure-related infarction). The mortality rate was 13.2% (5/38), and 84.2% of patients (32/38) had favorable outcomes. Thirty-two (84.2%) patients underwent follow-up angiographic evaluations; of these, 84.4% (27 patients) had complete occlusion and 15.6% had incomplete obliteration. Multivariate analysis revealed that early PED placement was not associated with a high risk of procedure-related stroke or an unfavorable outcome. Adjunctive coiling exhibited an association with procedure-related stroke ( = 0.073). Procedure-related hemorrhagic complications were significantly associated with an unfavorable outcome ( = 0.003). Immediate contrast stasis in the venous phase was associated with complete occlusion during follow-up ( = 0.050). The PED is a feasible and effective treatment to prevent rebleeding and achieve aneurysm occlusion, but it is associated with a substantial risk of periprocedural hemorrhage and ischemic complications in acute ruptured IAs. Therefore, the PED should be used selectively for acutely ruptured IAs. Additionally, adjunctive coiling might increase procedure-related stroke; however, it may reduce aneurysm rebleeding in acutely ruptured IAs. Patients with immediate contrast stasis in the venous phase were more likely to achieve total occlusion. A prospective study with a larger sample size should be performed to verify our results.
血流导向装置在破裂颅内动脉瘤（IA）治疗中的应用仍较为有限。我们旨在展示我们多中心使用管道栓塞装置（PED）治疗难以通过夹闭和线圈栓塞治疗的破裂IA的经验。回顾性分析了2015年至2020年接受PED治疗的38例破裂IA患者。分析了与手术相关的卒中（缺血性和出血性）以及临床和血管造影结果相关的因素。其中有14例（36.8%）囊状IA，12例（31.6%）水泡状IA，12例（31.6%）夹层IA。10例（26.3%）IA存在穿支受累。分别有27例（71.1%）和22例（57.9%）患者进行了早期PED置入（≤15天）和辅助线圈栓塞治疗。与卒中相关的并发症总发生率为31.6%（12/38）（包括手术相关出血性并发症发生率为10.5%，手术相关梗死发生率为15.8%）。死亡率为13.2%（5/38），84.2%的患者（32/38）预后良好。32例（84.2%）患者接受了随访血管造影评估；其中，84.4%（27例）完全闭塞，15.6%不完全闭塞。多因素分析显示，早期PED置入与手术相关卒中的高风险或不良预后无关。辅助线圈栓塞与手术相关卒中存在关联（P = 0.073）。手术相关出血性并发症与不良预后显著相关（P = 0.003）。静脉期即刻造影剂滞留与随访期间完全闭塞相关（P = 0.050）。PED是预防再出血和实现动脉瘤闭塞的一种可行且有效的治疗方法，但在急性破裂IA中与围手术期出血和缺血性并发症的高风险相关。因此，PED应选择性用于急性破裂IA。此外，辅助线圈栓塞可能会增加手术相关卒中；然而，它可能会减少急性破裂IA中的动脉瘤再出血。静脉期即刻造影剂滞留的患者更有可能实现完全闭塞。应进行更大样本量的前瞻性研究以验证我们的结果。
