Strittmatter Catherine, Meyer Lukas, Broocks Gabriel, Alexandrou Maria, Politi Maria, Boutchakova Maria, Henssler Andreas, Reinges Marcus, Simgen Andreas, Papanagiotou Panagiotis, Roth Christian
Department of Neurosurgery, Hospital Bremen-Mitte, 28205 Bremen, Germany.
Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany.
J Clin Med. 2022 Jun 16;11(12):3469. doi: 10.3390/jcm11123469.
Previous case series have described the safety and efficacy of different stent models for stent-assisted aneurysm coiling (SAC), but comparative analyses of procedural results are limited. This study investigates the procedural outcome and safety of three different stent models (Atlas™, LEO+™ (Baby) and Enterprise™) in the setting of elective SAC treated at a tertiary neuro-endovascular center. We retrospectively reviewed all consecutively treated patients that received endovascular SAC for intracranial aneurysms between 1 July 2013 and 31 March 2020, excluding all emergency angiographies for acute subarachnoid hemorrhage. The primary procedural outcome was the occlusion rate evaluated with the Raymond-Roy occlusion classification (RROC) assessed on digital subtraction angiography (DSA) at 6- and 12-month follow-up. Safety assessment included periprocedural adverse events (i.e., symptomatic ischemic complications, symptomatic intracerebral hemorrhage, iatrogenic perforation, dissection, or aneurysm rupture and in-stent thrombosis) and in-house mortality. Uni- and multivariable logistic regression analyses were performed to identify patient baseline and aneurysm characteristics that were associated with complete aneurysm obliteration at follow-up. A total of 156 patients undergoing endovascular treatment via SAC met the inclusion criteria. The median age was 62 years (IQR, 55-71), and 73.7% (115) of patients were female. At first follow-up (6-month) and last available follow-up (12 and 18 months), complete aneurysm occlusion was observed in 78.3% (90) and 76.9% (102) of patients, respectively. There were no differences regarding the occlusion rates stratified by stent model. Multivariable logistic analysis revealed increasing dome/neck ratio (adjusted odds ratio (aOR), 0.26.; 95% CI, 0.11-0.64; = 0.003), increasing neck size (aOR, 0.70; 95% CI, 0.51-0.96; = 0.027), and female sex (aOR, 4.37; 95% CI, 1.68-11.36; = 0.002) as independently associated with treatment success. This study showed comparable rates of complete long-term aneurysm obliteration and safety following SAC for intracranial aneurysm with three different stent-models highlighting the procedural feasibility of this treatment strategy with currently available stent-models. Increased neck size and a higher dome/neck ratio were independent variables associated with less frequent complete aneurysm obliteration.
既往病例系列研究描述了不同支架模型用于支架辅助动脉瘤栓塞术（SAC）的安全性和有效性，但对手术结果的比较分析有限。本研究调查了在一家三级神经血管内治疗中心进行的择期SAC中，三种不同支架模型（Atlas™、LEO+™（Baby）和Enterprise™）的手术结果及安全性。我们回顾性分析了2013年7月1日至2020年3月31日期间所有接受颅内动脉瘤血管内SAC治疗的连续患者，排除所有急性蛛网膜下腔出血的急诊血管造影。主要手术结果是在6个月和12个月随访时通过数字减影血管造影（DSA）采用雷蒙德 - 罗伊闭塞分级（RROC）评估的闭塞率。安全性评估包括围手术期不良事件（即有症状的缺血性并发症、有症状的脑出血、医源性穿孔、夹层形成、动脉瘤破裂和支架内血栓形成）以及院内死亡率。进行单变量和多变量逻辑回归分析以确定与随访时动脉瘤完全闭塞相关的患者基线和动脉瘤特征。共有156例接受SAC血管内治疗的患者符合纳入标准。中位年龄为62岁（四分位间距，55 - 71岁），73.7%（115例）为女性。在首次随访（6个月）和最后一次可用随访（12个月和18个月）时，分别有78.3%（90例）和76.9%（102例）的患者动脉瘤完全闭塞。按支架模型分层的闭塞率无差异。多变量逻辑分析显示，瘤顶/瘤颈比值增加（调整后的优势比（aOR），0.26；95%置信区间，0.11 - 0.64；P = 0.003）、瘤颈尺寸增加（aOR，0.70；95%置信区间，0.51 - 0.96；P = 0.027）以及女性（aOR，4.37；95%置信区间，1.68 - 11.36；P = 0.002）与治疗成功独立相关。本研究表明，使用三种不同支架模型进行颅内动脉瘤SAC后，长期动脉瘤完全闭塞率和安全性相当，突出了使用现有支架模型进行该治疗策略的手术可行性。瘤颈尺寸增加和较高的瘤顶/瘤颈比值是与动脉瘤完全闭塞频率较低相关的独立变量。
