Radiology, CHU Reims, Reims, France
Research on Health University department, University of Reims Champagne-Ardenne, Reims, France.
J Neurointerv Surg. 2022 Nov;14(11):1096-1101. doi: 10.1136/neurintsurg-2021-017972. Epub 2021 Nov 5.
One limitation of the endovascular treatment of intracranial aneurysms is aneurysm recanalization. The Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm (ARETA) study is a prospective multicenter cohort study evaluating the factors associated with recanalization after endovascular treatment.
The current analysis is focused on patients treated by coiling or balloon-assisted coiling (BAC). Postoperative, mid-term vascular imaging, and evolution of aneurysm occlusion were independently evaluated by two neuroradiologists. A 3-grade scale was used for aneurysm occlusion (complete occlusion, neck remnant, and aneurysm remnant) and for occlusion evolution (improved, stable, and worsened). Recanalization was defined as any worsening of aneurysm occlusion.
Between December 2013 and May 2015, 16 French neurointerventional departments enrolled 1289 patients. A total of 945 aneurysms in 908 patients were treated with coiling or BAC. The overall rate of aneurysm recanalization at mid-term follow-up was 29.5% (95% CI 26.6% to 32.4%): 28.9% and 30.3% in the coiling and BAC groups, respectively. In multivariate analyses factors independently associated with recanalization were current smoking (36.6% in current smokers vs 24.5% in current non-smokers (OR 1.8 (95% CI 1.3 to 2.4); p=0.0001), ruptured status (31.9% in ruptured aneurysms vs 25.1% in unruptured (OR 1.5 (95% CI 1.1 to 2.1); p=0.006), aneurysm size ≥10 mm (48.8% vs 26.5% in aneurysms <10 mm (OR 2.6 (95% CI 1.8 to 3.9); p<0.0001), wide neck (32.1% vs 25.8% in narrow neck (OR 1.5 (95% CI 1.1 to 2.1); p=0.02), and MCA location (34.3% vs 28.3% in other locations (OR 1.5 (95% CI 1.0 to 2.1); p=0.04).
Several factors are identified by the ARETA study as playing a role in aneurysm recanalization after coiling: current smoking, aneurysm status (ruptured), aneurysm size (≥10 mm), neck size (wide neck), and aneurysm location (middle cerebral artery). This finding has important consequences in clinical practice.
URL: http://www.
gov; Unique Identifier: NCT01942512.
颅内动脉瘤血管内治疗的一个局限性是动脉瘤再通。颅内动脉瘤血管内治疗后再通分析（ARETA）研究是一项前瞻性多中心队列研究，评估血管内治疗后再通相关的因素。
目前的分析集中在使用线圈或球囊辅助线圈（BAC）治疗的患者。术后、中期血管成像和动脉瘤闭塞的演变由两名神经放射学家独立评估。使用 3 级量表评估动脉瘤闭塞（完全闭塞、颈部残留和动脉瘤残留）和闭塞演变（改善、稳定和恶化）。再通被定义为动脉瘤闭塞的任何恶化。
2013 年 12 月至 2015 年 5 月期间，16 个法国神经介入部门共纳入 1289 例患者。908 例患者共 945 个动脉瘤接受了线圈或 BAC 治疗。中期随访的总体动脉瘤再通率为 29.5%（95%CI26.6%至 32.4%）：线圈组为 28.9%，BAC 组为 30.3%。多变量分析表明，与再通相关的独立因素有：当前吸烟（当前吸烟者为 36.6%，当前不吸烟者为 24.5%（OR1.8（95%CI1.3 至 2.4）；p=0.0001）、破裂状态（破裂动脉瘤为 31.9%，未破裂动脉瘤为 25.1%（OR1.5（95%CI1.1 至 2.1）；p=0.006）、动脉瘤大小≥10mm（动脉瘤大小≥10mm 者为 48.8%，<10mm 者为 26.5%（OR2.6（95%CI1.8 至 3.9）；p<0.0001）、宽颈（颈宽者为 32.1%，颈窄者为 25.8%（OR1.5（95%CI1.1 至 2.1）；p=0.02）和 MCA 位置（MCA 位置者为 34.3%，其他位置者为 28.3%（OR1.5（95%CI1.0 至 2.1）；p=0.04）。
ARETA 研究确定了几个与线圈后动脉瘤再通相关的因素：当前吸烟、动脉瘤状态（破裂）、动脉瘤大小（≥10mm）、颈部大小（宽颈）和动脉瘤位置（大脑中动脉）。这一发现对临床实践具有重要意义。
