Gaudino Chiara, Navone Stefania Elena, Da Ros Valerio, Guarnaccia Laura, Marfia Giovanni, Pantano Patrizia, Peschillo Simone, Triulzi Fabio Maria, Biraschi Francesco
Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.
Department of Neuroradiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
Front Neurol. 2023 Jan 11;13:1096651. doi: 10.3389/fneur.2022.1096651. eCollection 2022.
Although endovascular treatment of ruptured intracranial aneurysms is well-established, some critical issues have not yet been clarified, such as the effects of timing on safety and effectiveness of the procedure. The aim of our study was to analyze the incidence of intra-procedural complications according to the timing of treatment, as they can affect morbidity and mortality.
We retrospectively analyzed all patients who underwent endovascular treatment for ruptured intracranial aneurysms at three high flow center. For all patients, imaging and clinical data, aneurysm's type, mean dimension and different treatment techniques were analyzed. Intra-procedural complications were defined as thrombus formation at the aneurysm's neck, thromboembolic events, and rupture of the aneurysm. Patients were divided into three groups according to time between subarachnoid hemorrhage and treatment (<12 h hyper-early, 12-36 h early, and >36 h delayed).
The final study population included 215 patients. In total, 84 patients (39%) underwent hyper-early, 104 (48%) early, and 27 (13%) delayed endovascular treatment. Overall, 69% of the patients were treated with simple coiling, 23% with balloon-assisted coiling, 1% with stent-assisted coiling, 3% with a flow-diverter stent, 3% with an intrasaccular flow disruptor device, and 0.5% with parent vessel occlusion. Delayed endovascular treatment was associated with an increased risk of total intra-procedural complications compared to both hyper-early ( = 0.009) and early ( = 0.004) treatments with a rate of complications of 56% (vs. 29% in hyper-early and 26% in early treated group- = 0.011 and = 0.008). The delayed treatment group showed a higher rate of thrombus formation and thromboembolic events. The increased risk of total intra-procedural complications in delayed treatment was confirmed, also considering only the patients treated with simple coiling and balloon-assisted coiling ( = 0.005 and = 0.003, respectively, compared to hyper-early and early group) with a rate of complications of 62% (vs. 28% in hyper-early and 26% in early treatments- = 0.007 and = 0.003). Also in this subpopulation, delayed treated patients showed a higher incidence of thrombus formation and thromboembolic events.
Endovascular treatment of ruptured intracranial aneurysms more than 36 h after SAH seems to be associated with a higher risk of intra-procedural complications, especially thrombotic and thromboembolic events.
尽管颅内破裂动脉瘤的血管内治疗已得到广泛认可，但一些关键问题尚未阐明，例如治疗时机对手术安全性和有效性的影响。我们研究的目的是分析根据治疗时机发生的术中并发症发生率，因为它们会影响发病率和死亡率。
我们回顾性分析了在三个高流量中心接受颅内破裂动脉瘤血管内治疗的所有患者。对所有患者，分析了影像学和临床数据、动脉瘤类型、平均尺寸和不同治疗技术。术中并发症定义为动脉瘤颈部血栓形成、血栓栓塞事件和动脉瘤破裂。根据蛛网膜下腔出血与治疗之间的时间将患者分为三组（<12小时超早期、12 - 36小时早期和>36小时延迟期）。
最终研究人群包括215例患者。总共，84例患者（39%）接受了超早期治疗，104例（48%）接受了早期治疗，27例（13%）接受了延迟血管内治疗。总体而言，69%的患者采用单纯弹簧圈栓塞治疗，23%采用球囊辅助弹簧圈栓塞治疗，1%采用支架辅助弹簧圈栓塞治疗，3%采用血流导向支架治疗，3%采用囊内血流阻断装置治疗，0.5%采用载瘤动脉闭塞治疗。与超早期（P = 0.009）和早期（P = 0.004）治疗相比，延迟血管内治疗与术中总并发症风险增加相关，并发症发生率为56%（超早期为29%，早期治疗组为26% - P = 0.011和P = 0.008）。延迟治疗组血栓形成和血栓栓塞事件发生率更高。在仅考虑采用单纯弹簧圈栓塞和球囊辅助弹簧圈栓塞治疗的患者时，也证实了延迟治疗术中总并发症风险增加（与超早期和早期组相比，分别为P = 0.005和P = 0.003），并发症发生率为62%（超早期为28%，早期治疗为26% - P = 0.007和P = 0.003）。在这个亚组中，延迟治疗的患者血栓形成和血栓栓塞事件发生率也更高。
蛛网膜下腔出血后超过36小时进行颅内破裂动脉瘤的血管内治疗似乎与术中并发症风险较高相关，尤其是血栓形成和血栓栓塞事件。
