Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 15th Floor, Louisville, KY, 40202, USA.
School of Medicine, University of Louisville, Louisville, KY, USA.
Acta Neurochir (Wien). 2024 Jul 10;166(1):293. doi: 10.1007/s00701-024-06186-9.
Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the aneurysm before clipping decreases IOR.
We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination.
We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0 mm [interquartile range 5.95-8.7] vs. 4.6 mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients.
Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.
术中破裂（IOR）是在破裂的颅内动脉瘤的手术夹闭过程中最常见的不良事件。除了增加外科医生的经验和早期近端控制外，目前尚无降低 IOR 风险的方法。因此，我们的目的是评估在夹闭前进行部分血管内线圈栓塞以保护动脉瘤是否会降低 IOR。
我们对在两个三级学术中心接受手术夹闭治疗的破裂颅内动脉瘤患者进行了回顾性分析。我们比较了接受部分血管内线圈栓塞以保护动脉瘤的患者与未接受栓塞的患者的患者特征和结局。主要结局是 IOR。次要结局是住院死亡率和出院去向。
我们分析了 100 名患者。在 27 名患者中进行了部分血管内动脉瘤保护。部分栓塞组和非栓塞组的年龄、性别、蛛网膜下腔出血严重程度和动脉瘤位置相似。部分栓塞动脉瘤的中位大小较大（7.0mm [四分位距 5.95-8.7] 比 4.6mm [3.3-6.0]；P<0.001）。在手术夹闭过程中，部分栓塞动脉瘤的 IOR 发生率低于非栓塞动脉瘤（2/27，7.4%，比 30/73，41%；P=0.001）。部分栓塞动脉瘤患者的住院死亡率为 14.8%（4/27），未栓塞患者为 28.8%（21/73）（P=0.20）。部分栓塞动脉瘤患者出院回家或住院康复的比例为 74.0%，未栓塞患者为 56.2%（P=0.11）。27 名部分栓塞患者中有 2 名（7.4%）出现部分栓塞并发症。
破裂动脉瘤的术前部分血管内线圈栓塞与手术夹闭治疗时 IOR 发生率降低有关。这些结果以及术前部分血管内线圈栓塞对功能结局的影响应通过随机试验来证实。
