Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.
J Neurointerv Surg. 2023 Jul;15(7):655-663. doi: 10.1136/jnis-2022-019151. Epub 2022 Sep 7.
Dolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs. We compared triple therapy (TT (DAPT plus oral anticoagulation)) and DAPT alone in patients with DVBFAs treated with FD.
Retrospective comparison of DAPT and TT in patients with DVBFAs treated with FD at eight US centers.
The groups (DAPT=13, TT=14) were similar in age, sex, clinical presentation, baseline disability, and aneurysm characteristics. Radial access use was significantly higher in the TT group (71.4% vs 15.3%; P=0.006). Median number of flow diverters and adjunctive coiling use were non-different between groups. Acute ischemic stroke rate during the oral anticoagulation period was lower in the TT group than the DAPT group (7.1% vs 30.8%; P=0.167). Modified Rankin Scale score decline was significantly lower in the TT group (7.1% vs 69.2%; P=0.001). Overall rates of hemorrhagic complications (TT, 28.6% vs DAPT, 7.7%; P=0.162) and complete occlusion (TT, 25% vs DAPT, 54.4%; P=0.213) were non-different between the groups. Rate of moderate-to-severe disability at last follow-up was significantly lower in the TT group (21.4% vs 76.9%; P=0.007).
Patients with DVBFAs treated with FD in the TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients in the DAPT group.
未经治疗的梭形延髓脑桥基底动脉扩张性动脉瘤（DVBFAs）自然病史较差，显微手术治疗的病死率和病残率高。血流导向装置（FD）联合双联抗血小板治疗（DAPT）是可行的，但存在穿支闭塞和脑干压迫进展的高风险。需要精心设计的抗血栓策略来保持穿支通畅，同时发生血管重塑。我们比较了双重抗血小板治疗（DAPT 加口服抗凝治疗）三联疗法（TT）和单纯 DAPT 治疗延髓脑桥基底动脉梭形扩张性动脉瘤 FD 的患者。
回顾性比较 8 家美国中心采用 FD 治疗的 DVBFAs 患者中 DAPT 和 TT 的治疗效果。
两组（DAPT=13，TT=14）在年龄、性别、临床表现、基线残疾和动脉瘤特征方面相似。TT 组（71.4%比 15.3%；P=0.006）中桡动脉入路的使用明显更高。两组间使用的血流导向装置数量和辅助弹簧圈数量无差异。TT 组在抗凝期间急性缺血性卒中发生率低于 DAPT 组（7.1%比 30.8%；P=0.167）。TT 组改良 Rankin 量表评分下降显著低于 DAPT 组（7.1%比 69.2%；P=0.001）。TT 组的总出血并发症发生率（28.6%比 DAPT 组的 7.7%；P=0.162）和完全闭塞率（25%比 DAPT 组的 54.4%；P=0.213）无差异。TT 组在最后随访时中度至重度残疾的发生率明显低于 DAPT 组（21.4%比 76.9%；P=0.007）。
与 DAPT 组的相似患者相比，接受 FD 治疗的延髓脑桥基底动脉梭形扩张性动脉瘤患者在 TT 组中发生缺血性卒中较少，症状进展较少，最后随访时总体预后较好。
