Pierot Laurent, Rouchaud Aymeric, Chabert Emmanuel, Desal Hubert, Ricolfi Frédéric, Barbe Coralie, Soize Sébastien, Zerroug Adberrahim, Eugène Francois, Clarençon Frédéric, Ferré Jean-Christophe
Department of Neuroradiology, CHU de Reims, Reims, France
Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.
J Neurointerv Surg. 2025 Jan 26. doi: 10.1136/jnis-2024-022051.
The rate of thromboembolic events (TEEs) associated with endovascular treatment (EVT) of intracranial aneurysms is not reported uniformly in the literature due to the various ways that are used to evaluate them. Analysis of Thromboembolic Complications after Endovascular Treatment of Unruptured Intracranial Aneurysms study (ACET) is a prospective, multicenter study, which analyzes the rate of TEEs using diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) in patients treated for unruptured aneurysms with different endovascular techniques.
Patients were prospectively included in six French centers. Postoperative DWI-MRI was performed within 72 hours post-procedure and independently evaluated. Univariate and multivariate analyses were conducted to determine factors associated with the occurrence of DWI lesions.
Of the 233 included patients (54.5±11.2 years, 162 women, (69.5%)), 226 were effectively treated by EVT (coiling: 90 patients, 39.8%; balloon-assisted coiling (BAC): 62, 27.4%; stent-assisted coiling (SAC): 10, 4.4%; flow diversion (FD): 21, 9.3%; intrasaccular flow disruption (ISFD): 43, 19.0%) and had a postoperative MRI showing DWI lesions in 133 patients (58.8%). Univariate and multivariate analyses show the rate of patients with DWI lesions to be significantly higher with BAC (75.8%, P=0.001), SAC (90.0%, P=0.02), and FD (95.2%, P=0.001) compared with coiling alone (41.1%).
The rate of DWI lesions after EVT of unruptured aneurysms is primarily influenced by the EVT technique used. Techniques using transient (BAC) or permanent (SAC and FD) device placement in the parent artery are associated with a higher rate of DWI lesions.
ACET: Unique identifier: NCT02862756.
由于评估颅内动脉瘤血管内治疗（EVT）相关血栓栓塞事件（TEEs）的方法各异，文献中对其发生率的报道并不统一。未破裂颅内动脉瘤血管内治疗后血栓栓塞并发症分析研究（ACET）是一项前瞻性多中心研究，该研究使用扩散加权成像（DWI）磁共振成像（MRI）分析采用不同血管内技术治疗未破裂动脉瘤患者的TEEs发生率。
前瞻性纳入法国6个中心的患者。术后72小时内进行DWI-MRI检查并独立评估。进行单因素和多因素分析以确定与DWI病变发生相关的因素。
纳入的233例患者（年龄54.5±11.2岁，女性162例，占69.5%）中，226例接受了有效的EVT治疗（弹簧圈栓塞：90例，占39.8%；球囊辅助弹簧圈栓塞（BAC）：62例，占27.4%；支架辅助弹簧圈栓塞（SAC）：10例，占4.4%；血流导向（FD）：21例，占9.3%；瘤内血流阻断（ISFD）：43例，占19.0%），术后MRI显示133例患者（占58.8%）有DWI病变。单因素和多因素分析显示，与单纯弹簧圈栓塞（41.1%）相比，BAC（75.8%，P=0.001）、SAC（90.0%，P=0.02）和FD（95.2%，P=0.001）患者的DWI病变发生率显著更高。
未破裂动脉瘤EVT后DWI病变发生率主要受所采用的EVT技术影响。在载瘤动脉中使用临时性（BAC）或永久性（SAC和FD）装置的技术与更高的DWI病变发生率相关。
ACET：唯一标识符：NCT02862756。
