颅内破裂动脉瘤蛛网膜下腔出血后 72 小时内行血管内栓塞治疗的安全性和有效性。
Safety and Efficacy of Endovascular Embolization of Ruptured Intracranial Aneurysms within 72 hours of Subarachnoid Hemorrhage.
机构信息
Department of Neurosurgery, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
出版信息
J Neurol Surg A Cent Eur Neurosurg. 2022 May;83(3):265-274. doi: 10.1055/s-0041-1731752. Epub 2021 Nov 17.
PURPOSE
The purpose of the study was to investigate the safety and efficacy of endovascular embolization of ruptured intracranial aneurysms within 72 hours of subarachnoid hemorrhage (SAH).
MATERIALS AND METHODS
Patients with intracranial aneurysms treated with embolization were divided into group A ( = 277), patients with ruptured aneurysms treated within 72 hours of SAH; group B ( = 138), patients with ruptured aneurysms treated beyond 72 hours; and group C ( = 93), patients with unruptured aneurysms.
RESULTS
Embolization was successful in all but four patients (99.2%). The periprocedural complication rate was 36.2% in group B, significantly ( < 0.05) greater than that in group A (24.5%) or group C (11.8%). The rebleeding rate was 9.7% (6/62 patients) in groups A and B after embolization and only 0.3% (1/346 patients) in aneurysms with total or subtotal occlusion. Of these three groups of patients, 69.7% in group A, 58.7% in group B, and 76.3% in group C achieved Glasgow Outcome Scale (GOS) score of 5 or modified Rankin Scale (mRS) score of 0- to 1 at discharge. A significant difference ( < 0.05) existed in the clinical outcome between the three groups. The percentages of patients without deficits (GOS 5 or mRS 0-1) and slight disability (mRS 2) were 80.2% in group A, 81.2% in group B, and 96.7% in group C. The mortality rate was 4.3% (12/277 patients) in group A and 7.2% (10/138 patients) in group B with no significant ( = 0.21) difference. Follow-up was performed at 3 to 54 months (mean 23.2), and the recanalization rate was 28.6% (32/112 patients) in group A, 22.4% (11/49 patients) in group B, and 28.6% (16/56 patients) in group C, with no significant differences ( = 0.15). Hydrocephalus occurred in 30.5% (39/128 patients) in group B, which was significantly ( < 0.01) greater than that in group A (9.4%) or group C (2.2%).
CONCLUSION
Early embolization of ruptured cerebral aneurysms within 72 hours of rupture is safe and effective and can significantly decrease periprocedural complications compared with management beyond 72 hours. Timely management of cisternal and ventricular blood can reduce hydrocephalus incidence and improve prognosis.
目的
本研究旨在探讨颅内破裂动脉瘤在蛛网膜下腔出血（SAH）后 72 小时内进行血管内栓塞治疗的安全性和疗效。
材料和方法
接受栓塞治疗的颅内动脉瘤患者分为 A 组（ = 277），为破裂动脉瘤且在 SAH 后 72 小时内接受治疗；B 组（ = 138），为破裂动脉瘤且在 72 小时后接受治疗；C 组（ = 93），为未破裂动脉瘤患者。
结果
除 4 例患者（99.2%）外，所有患者均成功栓塞。B 组围手术期并发症发生率为 36.2%，明显（ < 0.05）高于 A 组（24.5%）或 C 组（11.8%）。栓塞后 A 组和 B 组再出血率为 9.7%（6/62 例），完全或次全闭塞的动脉瘤再出血率为 0.3%（1/346 例）。在这三组患者中，A 组 69.7%、B 组 58.7%和 C 组 76.3%在出院时达到格拉斯哥预后量表（GOS）评分 5 分或改良 Rankin 量表（mRS）评分 0-1。三组间临床结局差异有统计学意义（ < 0.05）。A 组无残疾（GOS 5 分或 mRS 0-1）和轻度残疾（mRS 2）的患者百分比为 80.2%，B 组为 81.2%，C 组为 96.7%。A 组死亡率为 4.3%（12/277 例），B 组为 7.2%（10/138 例），差异无统计学意义（ = 0.21）。随访 3-54 个月（平均 23.2 个月），A 组再通率为 28.6%（32/112 例），B 组为 22.4%（11/49 例），C 组为 28.6%（16/56 例），差异无统计学意义（ = 0.15）。B 组脑积水发生率为 30.5%（39/128 例），明显（ < 0.01）高于 A 组（9.4%）或 C 组（2.2%）。
结论
破裂动脉瘤在破裂后 72 小时内进行早期栓塞治疗是安全有效的，与超过 72 小时的治疗相比，可显著降低围手术期并发症。及时处理脑池和脑室积血可降低脑积水发生率，改善预后。
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