Ma Chao, Zhu Haoyu, Liang Shikai, Liang Fei, Sun Jidian, Zhang Yupeng, Jiang Chuhan
School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Front Neurol. 2022 May 18;13:755122. doi: 10.3389/fneur.2022.755122. eCollection 2022.
Coiling and stent-assisted coiling remain the first-line treatments for distal cerebral circulation aneurysms (DCCAs). The off-label use of the pipeline embolization device (PED) for these aneurysms has been explored recently but remains controversial.
To compare traditional endovascular therapeutic approaches (coiling and stent-assisted coiling) and PED for DCCAs in a multicenter cohort of patients.
A multicenter, retrospective cohort comparison study was conducted that included consecutive patients with unruptured DCCAs treated with either traditional endovascular therapeutic approaches or PED placement at three centers between 2016 and 2020. Propensity score matching analysis was applied to adjust for baseline risk factors between the PED and TET groups. Matching was based on age, sex, aneurysm size, location, morphology, adjunctive coiling, treatment history, and preoperative mRS score.
In total, 209 patients with DCCAs treated with PED or traditional endovascular therapeutic approaches were identified. Thirty-seven patients underwent PED treatment, and 172 patients underwent traditional endovascular therapeutic approaches. After propensity score matching, 37 aneurysm pairs were matched, and the baseline characteristics of the patients were balanced between the groups. The complete occlusion rate between PED and traditional endovascular therapeutic approach in both matched cohorts (91.7 vs. 92.3%, > 0.78) was similar. The rate of periprocedural treatment-related complications in both the PED and traditional endovascular therapeutic groups was 13.5%. Univariate analysis identified average parent vessel diameter as the only predictor of complete occlusion ( = 0.038).
PED is a viable option for treating DCCAs by providing occlusion and complication rates similar to those of traditional endovascular therapeutic approaches. A rigid patient selection procedure and proper planning should be undertaken to reduce treatment-related complications.
弹簧圈栓塞和支架辅助弹簧圈栓塞仍是大脑远端循环动脉瘤（DCCA）的一线治疗方法。近年来，人们对管道栓塞装置（PED）在这些动脉瘤治疗中的超适应证使用进行了探索，但仍存在争议。
在多中心队列患者中比较传统血管内治疗方法（弹簧圈栓塞和支架辅助弹簧圈栓塞）与PED治疗DCCA的效果。
进行了一项多中心回顾性队列比较研究，纳入2016年至2020年间在三个中心接受传统血管内治疗方法或PED置入治疗的连续未破裂DCCA患者。应用倾向评分匹配分析来调整PED组和传统血管内治疗组之间的基线风险因素。匹配基于年龄、性别、动脉瘤大小、位置、形态、辅助弹簧圈栓塞、治疗史和术前改良Rankin量表（mRS）评分。
共确定了209例接受PED或传统血管内治疗方法治疗的DCCA患者。37例患者接受了PED治疗，172例患者接受了传统血管内治疗方法。倾向评分匹配后，匹配了37对动脉瘤，两组患者的基线特征达到平衡。两个匹配队列中，PED组和传统血管内治疗方法组的完全闭塞率相似（91.7%对92.3%，P>0.78）。PED组和传统血管内治疗组围手术期治疗相关并发症发生率均为13.5%。单因素分析确定平均母血管直径是完全闭塞的唯一预测因素（P=0.038）。
PED是治疗DCCA的一种可行选择，其闭塞率和并发症发生率与传统血管内治疗方法相似。应采用严格的患者选择程序并进行适当规划，以减少治疗相关并发症。
