De Leacy Reade, Bageac Devin V, Siddiqui Neha, Bellon Richard J, Park Min S, Schirmer Clemens M, Woodward Keith B, Zaidat Osama O, Spiotta Alejandro M
Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States.
Radiology Imaging Associates PC, Englewood, CO, United States.
Front Neurol. 2022 Feb 7;13:830296. doi: 10.3389/fneur.2022.830296. eCollection 2022.
Wide-necked middle cerebral artery bifurcation aneurysms pose specific challenges to endovascular management. Surgical clipping remains the standard treatment approach for these aneurysms in many centers. While recent data suggests the endovascular treatment may be comparable, a prospective datapoint has been lacking.
The Penumbra SMART registry, a prospective, multi-center, single-arm outcomes registry of Penumbra coil-treated aneurysms, was queried for endovascularly treated MCA bifurcation aneurysms with wide necks (dome:neck ratio <2 or neck >4 mm). Safety and efficacy outcomes were summarized for ruptured and unruptured aneurysms, including rupture, complication rate, and 1-year occlusion outcomes.
Seventy-two aneurysms across 31 sites were enrolled. Of these, a total of 15 presented as ruptured aneurysms. Serious adverse events were reported in 21 (29.2%) of patients, with 8 (11.1%) attributed to the device/procedure. Immediately postoperatively, 75.0% of cases achieved "adequate" Raymond Roy Class I (40.3%) or II (34.7%) occlusion outcomes. Of the 72 patients treated, 60 (83.3%) underwent follow-up angiography at 1 year, and among these, 95.0% had 1-year occlusion outcomes of Raymond Roy Class I (71.7%) or II (23.3%). A total of 6 aneurysms (10.0%) were required or were planned for retreatment at the last follow-up.
This study represents the most significant prospective sample of endovascularly treated wide-neck MCA bifurcation aneurysms conducted to date. It supports the safety and efficacy of endovascular treatment of these aneurysms.
宽颈大脑中动脉分叉部动脉瘤的血管内治疗面临特殊挑战。在许多中心，手术夹闭仍是这些动脉瘤的标准治疗方法。虽然近期数据表明血管内治疗可能具有可比性，但一直缺乏前瞻性数据点。
查询了Penumbra SMART注册库，这是一个关于Penumbra弹簧圈治疗动脉瘤的前瞻性、多中心、单臂结局注册库，以获取血管内治疗的宽颈大脑中动脉分叉部动脉瘤（瘤顶：瘤颈比<2或瘤颈>4mm）。总结了破裂和未破裂动脉瘤的安全性和有效性结局，包括破裂情况、并发症发生率和1年闭塞结局。
31个部位的72个动脉瘤被纳入研究。其中，共有15个为破裂动脉瘤。21例（29.2%）患者报告了严重不良事件，其中8例（11.1%）归因于器械/手术。术后即刻，75.0%的病例达到“充分”的Raymond Roy I级（40.3%）或II级（34.7%）闭塞结局。在接受治疗的72例患者中，60例（83.3%）在1年时接受了随访血管造影，其中95.0%的患者1年闭塞结局为Raymond Roy I级（71.7%）或II级（23.3%）。在最后一次随访时，共有6个动脉瘤（10.0%）需要或计划再次治疗。
本研究是迄今为止进行的血管内治疗宽颈大脑中动脉分叉部动脉瘤的最大规模前瞻性样本。它支持这些动脉瘤血管内治疗的安全性和有效性。
