低剖面可视化腔内支撑支架辅助 Hydrocoil 栓塞治疗急性破裂宽颈颅内动脉瘤：倾向评分匹配队列研究。
Low profile visualized intraluminal support stent-assisted Hydrocoil embolization for acutely ruptured wide-necked intracranial aneurysms: A propensity score-matched cohort study.
机构信息
Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China.
Department of Neurosurgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong 510010, China.
出版信息
Clin Neurol Neurosurg. 2022 Jul;218:107302. doi: 10.1016/j.clineuro.2022.107302. Epub 2022 May 21.
PURPOSE
To compare the safety and efficacy of low profile visualized intraluminal support (LVIS) stent-assisted hydrogel coil embolization and LVIS stent-assisted bare platinum coil embolization for acutely ruptured wide-necked intracranial.
METHODS
89 patients who underwent LVIS stent-assisted hydrogel coil embolization (hydrogel coil group) and 145 patients who underwent LVIS stent-assisted bare platinum coil embolization (platinum coil group) were retrospectively reviewed after 1:2 propensity score matching (PSM). Procedure-related complications, clinical and angiographic follow-up outcomes were compared between the two groups.
RESULTS
All baseline characteristics were equivalent between hydrogel coil group and platinum coil group after PSM. There were no statistical differences in immediate postoperative embolization results, clinical and angiographic follow-up outcomes between the two groups (P = 0.514, P = 0.323 and P = 0.949, respectively). Intraprocedural aneurysm rupture, intraprocedural thrombosis and postprocedural thrombosis occurred in 2 patients (2.2%, 2/89), 1 patient (1.1%, 1/89) and 1 patient (1.1%, 1/89) of the hydrogel coil group compared with 1 patient (0.7%, 1/145), 1 patient (0.7%, 1/145) and 2 patients (1.4%, 2/145) of the platinum coil group, respectively (P = 0.559, P = 1.000 and P = 1.000). Nevertheless, the rate of postprocedural aneurysm early rebleeding in the hydrogel coil group was significantly lower than that in the platinum coil group (0.0% vs 4.8%, P = 0.046).
CONCLUSION
LVIS stent-assisted hydrogel coil embolization may reduce the risk of aneurysm early rebleeding compared with LVIS stent-assisted bare platinum coil embolization for the treatment of acutely ruptured wide-necked intracranial aneurysms, which implies that hydrogel coil may improve the safety of stent placement for ruptured intracranial aneurysms.
目的
比较低剖面可视化腔内支撑（LVIS）支架辅助水凝胶圈栓塞与 LVIS 支架辅助裸铂圈栓塞治疗急性破裂宽颈颅内动脉瘤的安全性和有效性。
方法
回顾性分析了 89 例行 LVIS 支架辅助水凝胶圈栓塞（水凝胶圈组）和 145 例行 LVIS 支架辅助裸铂圈栓塞（铂圈组）患者的资料。采用 1:2 倾向评分匹配（PSM）后，比较两组患者的围手术期并发症、临床和血管造影随访结果。
结果
PSM 后，水凝胶圈组和铂圈组患者的所有基线特征均无统计学差异。两组患者即刻术后栓塞效果、临床和血管造影随访结果无统计学差异（P=0.514、P=0.323 和 P=0.949）。水凝胶圈组有 2 例（2.2%，2/89）、1 例（1.1%，1/89）和 1 例（1.1%，1/89）患者分别发生术中动脉瘤破裂、术中血栓形成和术后血栓形成，铂圈组有 1 例（0.7%，1/145）、1 例（0.7%，1/145）和 2 例（1.4%，2/145）患者分别发生术中动脉瘤破裂、术中血栓形成和术后血栓形成，两组间差异无统计学意义（P=0.559、P=1.000 和 P=1.000）。然而，水凝胶圈组患者术后早期动脉瘤再出血率显著低于铂圈组（0.0%比 4.8%，P=0.046）。
结论
与 LVIS 支架辅助裸铂圈栓塞治疗急性破裂宽颈颅内动脉瘤相比，LVIS 支架辅助水凝胶圈栓塞可能降低动脉瘤早期再出血风险，这提示水凝胶圈可能改善破裂颅内动脉瘤支架置入的安全性。
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