Ge Huijian, Chen Xiheng, Liu Kai, Zhao Yang, Zhang Longhui, Liu Peng, Jiang Yuhua, He Hongwei, Lv Ming, Li Youxiang
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2022 Mar 2;13:843839. doi: 10.3389/fneur.2022.843839. eCollection 2022.
This study aimed to investigate clinical and angiographic outcomes of Pipeline embolization device (PED) treatment of large or giant basilar artery (BA) aneurysms and examine associated factors.
Clinical and angiographic data of 29 patients (18 men, 11 women) with large or giant BA aneurysms were retrospectively examined. Mean age was 44.1 ± 21.2 years (range, 30-68). Mean aneurysm size was 22.2 ± 8.3 mm (range, 12.0-40.1).
Mean angiographic follow-up was 18.3 ± 3.4 months (range, 4.5-60). The rate of adequate aneurysmal occlusion (O'Kelly-Marotta grade C-D) was 87%. The overall complication rate was 44.8%; most complications (84.6%) occurred in the periprocedural period. Univariable comparison of patients who did and did not develop complications showed significant differences in aneurysm size ( < 0.01), intra-aneurysmal thrombus ( = 0.03), and mean number of PEDs used ( = 0.02). Aneurysm size (odds ratio, 1.4; = 0.04) was an independent risk factor for periprocedural complications in multivariable analysis. Mean clinical follow-up was 23.5 ± 3.2 months (range, 0.1-65). Nine patients (31%) had a poor clinical outcome (modified Rankin scale score ≥3) at last follow-up, including 7 patients who died. Univariable comparisons between patients with favorable and unfavorable clinical outcomes showed that aneurysm size ( = 0.009) and intra-aneurysmal thrombus ( = 0.04) significantly differed between the groups. Multivariable analysis showed that aneurysm size (odds ratio, 1.1; = 0.04) was an independent risk factor for poor clinical outcome.
PED treatment of large or giant BA aneurysms is effective and can achieve a satisfactory long-term occlusion rate. However, the treatment complications are not negligible. Aneurysm size is the strongest predictor of perioperative complications and poor clinical outcome.
本研究旨在探讨采用Pipeline栓塞装置（PED）治疗大型或巨大型基底动脉（BA）动脉瘤的临床和血管造影结果，并研究相关因素。
回顾性分析29例（18例男性，11例女性）大型或巨大型BA动脉瘤患者的临床和血管造影数据。平均年龄为44.1±21.2岁（范围30 - 68岁）。平均动脉瘤大小为22.2±8.3mm（范围12.0 - 40.1mm）。
血管造影平均随访时间为18.3±3.4个月（范围4.5 - 60个月）。动脉瘤充分闭塞率（O'Kelly-Marotta分级C - D级）为87%。总体并发症发生率为44.8%；大多数并发症（84.6%）发生在围手术期。对发生和未发生并发症的患者进行单因素比较显示，动脉瘤大小（<0.01）、瘤内血栓（=0.03）和使用的PED平均数量（=0.02）存在显著差异。在多因素分析中，动脉瘤大小（比值比，1.4；=0.04）是围手术期并发症的独立危险因素。平均临床随访时间为23.5±3.2个月（范围0.1 - 65个月）。9例患者（31%）在最后一次随访时临床结局较差（改良Rankin量表评分≥3），其中7例死亡。临床结局良好和不良的患者之间的单因素比较显示，两组之间动脉瘤大小（=0.009）和瘤内血栓（=0.04）存在显著差异。多因素分析显示，动脉瘤大小（比值比，1.1；=0.04）是临床结局不良的独立危险因素。
采用PED治疗大型或巨大型BA动脉瘤是有效的，可实现令人满意的长期闭塞率。然而，治疗并发症不容忽视。动脉瘤大小是围手术期并发症和临床结局不良的最强预测因素。
