Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Neurosurg Rev. 2024 Jul 15;47(1):330. doi: 10.1007/s10143-024-02580-0.
Despite advancements in treatment modalities such as flow diverters, the optimal management of posterior communicating artery (PComA) aneurysms remains uncertain. While PComA aneurysms treated with the Pipeline Embolization Device (PED) has been reported, the characteristics and progression of incomplete occluded aneurysms remain unclear. Therefore, our study aims to investigate the occlusion status and recurrence rates of PComA aneurysms treated with PED. A retrospective review of consecutive PComA aneurysm patients treated with PED was conducted between January 2015 and December 2020. Only patients with radiological follow-up were included. PComA aneurysms were categorized into incomplete occlusion and complete occlusion group. The primary outcomes included the characteristics of incomplete occlusion at the follow-up angiography. Among 121 PComA aneurysms treated with PED at our institution, 80 aneurysms were eligible in our study. During the follow-up period, 19 (23.8%) aneurysms demonstrated incomplete occlusion. Notably, there were no instances of recurrence among the 80 followed-up cases. Baseline characteristics of patients and aneurysms were comparable between the groups with complete and incomplete occlusion. However, the incomplete occlusion group showed a lower rate of assisted coils embolization (21.2% vs. 55.7%, P = 0.017) and shorter median operative time (91.0 vs. 145.5 min, P = 0.039). Differences in functional outcomes, complications, and PComA occlusion status between the groups were not significant. Multivariate analysis revealed the use of coils was associated with lower odds of incomplete PComA aneurysm occlusion (OR 0.01, 95% CI 0.001-0.12; P = 0.001), while aneurysm size was associated with higher odds of incomplete occlusion (OR 1.25, 95% CI 1.10-1.46; P = 0.002). The treatment of PED for PComA aneurysm demonstrated favorable outcomes, with an acceptable rate of incomplete occlusion and no instances of recurrence observed. However, further research is needed to explore the optimal procedural strategy for large-sized PComA aneurysms.
尽管在治疗方式如血流导向装置方面取得了进展，但后交通动脉（PComA）动脉瘤的最佳治疗方法仍不确定。虽然已经报道了使用 Pipeline 栓塞装置（PED）治疗 PComA 动脉瘤，但不完全闭塞动脉瘤的特征和进展仍不清楚。因此，我们的研究旨在探讨使用 PED 治疗的 PComA 动脉瘤的闭塞状态和复发率。对 2015 年 1 月至 2020 年 12 月期间在我院接受 PED 治疗的连续 PComA 动脉瘤患者进行回顾性研究。仅纳入有影像学随访的患者。PComA 动脉瘤分为不完全闭塞组和完全闭塞组。主要结局包括随访血管造影时不完全闭塞的特征。在我院接受 PED 治疗的 121 个 PComA 动脉瘤中，80 个动脉瘤符合本研究标准。在随访期间，19 个（23.8%）动脉瘤显示不完全闭塞。值得注意的是，在 80 例随访病例中均未出现复发。完全闭塞组和不完全闭塞组患者和动脉瘤的基线特征相似。然而，不完全闭塞组辅助线圈栓塞率较低（21.2%比 55.7%，P=0.017），手术时间中位数较短（91.0 比 145.5 分钟，P=0.039）。两组之间的功能结局、并发症和 PComA 闭塞状态差异无统计学意义。多变量分析显示，使用线圈与较低的不完全 PComA 动脉瘤闭塞可能性相关（OR 0.01，95%CI 0.001-0.12；P=0.001），而动脉瘤大小与较高的不完全闭塞可能性相关（OR 1.25，95%CI 1.10-1.46；P=0.002）。PED 治疗 PComA 动脉瘤的效果良好，不完全闭塞率可接受，未观察到复发。然而，需要进一步研究来探讨大型 PComA 动脉瘤的最佳手术策略。
