Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Sci Rep. 2021 Nov 5;11(1):21742. doi: 10.1038/s41598-021-01156-y.
Stent-assisted coiling (SAC) for ruptured intracranial aneurysms (RIAs) remains controversial due to an inherent risk of potential thromboembolic and hemorrhagic complications. We compared SAC and coiling alone for the management of RIAs using propensity score-adjustment. Sixty-four patients treated by SAC and 220 by stand-alone coiling were retrospectively reviewed and compared using inverse probability of treatment weighting (IPTW) with propensity scores. Functional outcome, procedure-related and overall complications and angiographic results were analyzed. Aneurysms treated by SAC had a larger diameter, a wider neck and were more frequently located at the posterior circulation. SAC had a higher risk for thromboembolic complications (17.2% vs. 7.7%, p = 0.025), however, this difference did not persist in the IPTW analysis (OR 1.2, 95% CI 0.7-2.3, adjusted p = 0.458). In the adjusted analysis, rates of procedural cerebral infarction (p = 0.188), ventriculostomy-related hemorrhage (p = 0.584), in-hospital mortality (p = 0.786) and 6-month favorable functional outcome (p = 0.471) were not significantly different between the two groups. SAC yielded a higher complete occlusion (80.0% vs. 67.2%, OR 3.2, 95% CI 1.9-5.4, p < 0.001) and a lower recanalization rate (17.5% vs. 26.1%, OR 0.3, 95% CI 0.2-0.6, p < 0.001) than stand-alone coiling at 6-month follow-up. In conclusion, SAC of large and wide-necked RIAs provided higher aneurysm occlusion and similar clinical outcome, when compared to stand-alone coiling.
支架辅助栓塞（SAC）治疗破裂颅内动脉瘤（RIAs）仍然存在争议，因为存在潜在的血栓栓塞和出血并发症的固有风险。我们使用倾向评分调整比较了 SAC 和单纯栓塞治疗 RIAs 的效果。回顾性分析了 64 例 SAC 治疗患者和 220 例单纯栓塞治疗患者，并使用倾向评分进行逆概率治疗加权（IPTW）比较。分析了功能结局、与操作相关的总体并发症和血管造影结果。SAC 治疗的动脉瘤直径较大，颈部较宽，更常位于后循环。SAC 发生血栓栓塞并发症的风险较高（17.2%比 7.7%，p=0.025），但在 IPTW 分析中差异并不显著（OR 1.2，95%CI 0.7-2.3，调整后 p=0.458）。在调整分析中，两组患者的操作相关脑梗死发生率（p=0.188）、脑室造口相关出血发生率（p=0.584）、住院期间死亡率（p=0.786）和 6 个月时良好的功能结局发生率（p=0.471）无显著差异。6 个月时 SAC 完全闭塞率更高（80.0%比 67.2%，OR 3.2，95%CI 1.9-5.4，p<0.001），再通率更低（17.5%比 26.1%，OR 0.3，95%CI 0.2-0.6，p<0.001）。总之，与单纯栓塞相比，SAC 治疗大且宽颈 RIAs 可提供更高的动脉瘤闭塞率和相似的临床结局。
