Department of Neurosurgery, Takarazuka City Hospital, Hyogo, Japan.
Department of Neurosurgery, Hyogo Medical University, 1-1 Mukogawa, 663-8501, Nishinomiya, Hyogo, Japan.
Clin Neuroradiol. 2023 Dec;33(4):1035-1044. doi: 10.1007/s00062-023-01305-y. Epub 2023 Jun 9.
Large vertebral and basilar fusiform aneurysms (VFA) are sometimes difficult to cure by endovascular treatment (EVT). We aimed to elucidate indicators of poor outcomes of EVT in patients with VFAs.
Clinical data from 48 patients with 48 unruptured VFAs in the Hyogo Medical University were retrospectively analyzed. The primary outcome was defined as satisfactory aneurysm occlusion (SAO) according to Raymond-Roy grading scale. The secondary and safety outcomes were a modified Rankin scale (mRS) score of 0-2 at 90 days, retreatment, major stroke, and aneurysm-related death after EVT.
The EVT included stent-assisted coiling (n = 24; 50%), flow diverter (n = 19; 40%), and parent artery occlusion (n = 5; 10%). The SAO was less frequently observed in large or thrombosed VFAs at 12 months (64%, p = 0.021 and 62%, p = 0.014, respectively), especially when the aneurysms were both large and thrombosed (50%, p = 0.0030). Retreatment was more common in large aneurysms (29%, p = 0.034), thrombosed (32%, p = 0.011), and large thrombosed aneurysms (38%, p = 0.0036). Although the proportion of mRS 0-2 at 90 days and major stroke showed no significant differences, that of post-treatment rupture was significantly larger in large thrombosed VFAs (19%, p = 0.032). Aneurysm-related death occurred by aneurysm rupture and was more frequent in large thrombosed VFA (19%, p = 0.032). Multivariate analysis showed SAO at 12 months was less common (adjusted odds ratio, OR: 0.036, 95% confidence interval, CI 0.00091-0.57; p = 0.018), and retreatment was more common (adjusted OR 43, 95% CI 4.0-1381; p = 0.0012) in large thrombosed VFA.
The large thrombosed VFAs were associated with poor outcomes after EVT including flow diverter.
大型椎动脉和基底动脉梭形动脉瘤（VFA）有时难以通过血管内治疗（EVT）治愈。我们旨在阐明 VFA 患者 EVT 预后不良的指标。
回顾性分析兵库医科大学 48 例未破裂 VFA 患者的临床资料。主要结局定义为根据 Raymond-Roy 分级标准的满意动脉瘤闭塞（SAO）。次要和安全性结局为 EVT 后 90 天改良 Rankin 量表（mRS）评分 0-2、再治疗、大卒中和与动脉瘤相关的死亡。
EVT 包括支架辅助线圈（n=24；50%）、血流改道器（n=19；40%）和母动脉闭塞（n=5；10%）。12 个月时，大型或血栓形成的 VFA 中 SAO 发生率较低（64%，p=0.021 和 62%，p=0.014），尤其是当动脉瘤既大又血栓形成时（50%，p=0.0030）。大型动脉瘤（29%，p=0.034）、血栓形成（32%，p=0.011）和大型血栓形成的动脉瘤（38%，p=0.0036）再治疗更为常见。尽管 90 天时 mRS 0-2 的比例和大卒中等无显著差异，但大型血栓形成的 VFA 中治疗后破裂的比例明显更大（19%，p=0.032）。与动脉瘤相关的死亡是由动脉瘤破裂引起的，在大型血栓形成的 VFA 中更为常见（19%，p=0.032）。多变量分析显示 12 个月时 SAO 发生率较低（调整后的优势比，OR：0.036，95%置信区间，CI 0.00091-0.57；p=0.018），大型血栓形成的 VFA 中再治疗更为常见（调整后的 OR 43，95%CI 4.0-1381；p=0.0012）。
大型血栓形成的 VFA 与 EVT 后包括血流改道器在内的不良结局相关。
