双层编织式与单层编织式EndoBridge装置治疗颅内动脉瘤的倾向评分匹配分析
Dual Layer vs Single Layer Woven EndoBridge Device in the Treatment of Intracranial Aneurysms: A Propensity Score-Matched Analysis.
作者信息
Dmytriw Adam A, Salim Hamza, Musmar Basel, Aslan Assala, Cancelliere Nicole M, McLellan Rachel M, Algin Oktay, Ghozy Sherief, Dibas Mahmoud, Lay Sovann V, Guenego Adrien, Renieri Leonardo, Carnevale Joseph, Saliou Guillaume, Mastorakos Panagiotis, Naamani Kareem El, Shotar Eimad, Premat Kevin, Möhlenbruch Markus, Kral Michael, Doron Omer, Chung Charlotte, Salem Mohamed M, Lylyk Ivan, Foreman Paul M, Vachhani Jay A, Shaikh Hamza, Župančić Vedran, Hafeez Muhammad U, Catapano Joshua, Waqas Muhammad, Tutino Vincent M, Ibrahim Mohamed K, Mohammed Marwa A, Imamoglu Cetin, Bayrak Ahmet, Rabinov James D, Ren Yifan, Schirmer Clemens M, Piano Mariangela, Kühn Anna L, Michelozzi Caterina, Elens Stéphanie, Starke Robert M, Hassan Ameer E, Ogilvie Mark, Sporns Peter, Jones Jesse, Brinjikji Waleed, Nawka Marie T, Psychogios Marios, Ulfert Christian, Diestro Jose Danilo Bengzon, Pukenas Bryan, Burkhardt Jan-Karl, Huynh Thien, Martinez-Gutierrez Juan Carlos, Essibayi Muhammed Amir, Sheth Sunil A, Spiegel Gary, Tawk Rabih, Lubicz Boris, Panni Pietro, Puri Ajit S, Pero Guglielmo, Nossek Erez, Raz Eytan, Killer-Oberfalzer Monika, Griessenauer Christoph J, Asadi Hamed, Siddiqui Adnan, Brook Allan L, Altschul David, Ducruet Andrew F, Albuquerque Felipe C, Regenhardt Robert W, Stapleton Christopher J, Kan Peter, Kalousek Vladimir, Lylyk Pedro, Boddu Srikanth, Knopman Jared, Aziz-Sultan Mohammad A, Tjoumakaris Stavropoula I, Clarençon Frédéric, Limbucci Nicola, Cuellar-Saenz Hugo H, Jabbour Pascal M, Pereira Vitor Mendes, Patel Aman B, Adeeb Nimer
机构信息
Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, MA, 02114, USA.
出版信息
Neurosurg Rev. 2024 Mar 14;47(1):116. doi: 10.1007/s10143-024-02341-z.
BACKGROUND
The Woven EndoBridge (WEB) devices have been used for treating wide neck bifurcation aneurysms (WNBAs) with several generational enhancements to improve clinical outcomes. The original device dual-layer (WEB DL) was replaced by a single-layer (WEB SL) device in 2013. This study aimed to compare the effectiveness and safety of these devices in managing intracranial aneurysms.
METHODS
A multicenter cohort study was conducted, and data from 1,289 patients with intracranial aneurysms treated with either the WEB SL or WEB DL devices were retrospectively analyzed. Propensity score matching was utilized to balance the baseline characteristics between the two groups. Outcomes assessed included immediate occlusion rate, complete occlusion at last follow-up, retreatment rate, device compaction, and aneurysmal rupture.
RESULTS
Before propensity score matching, patients treated with the WEB SL had a significantly higher rate of complete occlusion at the last follow-up and a lower rate of retreatment. After matching, there was no significant difference in immediate occlusion rate, retreatment rate, or device compaction between the WEB SL and DL groups. However, the SL group maintained a higher rate of complete occlusion at the final follow-up. Regression analysis showed that SL was associated with higher rates of complete occlusion (OR: 0.19; CI: 0.04 to 0.8, p = 0.029) and lower rates of retreatment (OR: 0.12; CI: 0 to 4.12, p = 0.23).
CONCLUSION
The WEB SL and DL devices demonstrated similar performances in immediate occlusion rates and retreatment requirements for intracranial aneurysms. The SL device showed a higher rate of complete occlusion at the final follow-up.
背景
编织型血管内桥接（WEB）装置已用于治疗宽颈分叉动脉瘤（WNBA），并经过了几代改进以改善临床疗效。原始的双层装置（WEB DL）于2013年被单层装置（WEB SL）取代。本研究旨在比较这些装置在治疗颅内动脉瘤方面的有效性和安全性。
方法
进行了一项多中心队列研究，回顾性分析了1289例接受WEB SL或WEB DL装置治疗的颅内动脉瘤患者的数据。采用倾向评分匹配法来平衡两组之间的基线特征。评估的结果包括即刻闭塞率、末次随访时的完全闭塞率、再治疗率、装置致密化以及动脉瘤破裂情况。
结果
在倾向评分匹配之前，接受WEB SL治疗的患者在末次随访时的完全闭塞率显著更高，而再治疗率更低。匹配后，WEB SL组和DL组在即刻闭塞率、再治疗率或装置致密化方面没有显著差异。然而，SL组在最终随访时仍保持较高的完全闭塞率。回归分析显示，SL与更高的完全闭塞率（OR：0.19；CI：0.04至0.8，p = 0.029）和更低的再治疗率（OR：0.12；CI：0至4.12，p = 0.23）相关。
结论
WEB SL和DL装置在颅内动脉瘤的即刻闭塞率和再治疗需求方面表现出相似的性能。SL装置在最终随访时显示出更高的完全闭塞率。
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