编织式腔内桥接术患者术后抗凝药物使用的影响：一项多中心倾向评分匹配研究
The Impact of Postprocedural Anticoagulant Use in Patients Undergoing Woven EndoBridge: A Multicenter Propensity Score-Matched Study.
作者信息
Musmar Basel, Salim Hamza Adel, Roy Joanna M, Adeeb Nimer, Fuleihan Antony A, Atallah Elias, Sizdahkhani Saman, Koduri Sravanthi, Karadimas Spyridon, Baba Bachar El, Howard Brian M, Grossberg Jonathan A, Scott Kyle W, Burkhardt Jan-Karl, Srinivasan Visish M, Erazu Fernanda, Hanel Ricardo A, Amllay Abdelaziz, Matouk Charles, MacNeil Andrew, Chalouhi Nohra, Gomez-Paz Santiago, Grandhi Ramesh, Jaikumar Vinay, Levy Elad, Siddiqui Adnan, Klaiman Max, Delgado Josser, Hoffman Haydn, Arthur Adam, Hasan David M, Notarianni Christina, Cuellar Hugo H, Guthikonda Bharat, Morcos Jacques, Tjoumakaris Stavropoula I, Gooch Michael Reid, Rosenwasser Robert H, Jabbour Pascal
机构信息
Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA.
Department of Neuroradiology, MD Anderson Medical Center, Houston, TX, USA.
出版信息
Transl Stroke Res. 2024 Dec 24. doi: 10.1007/s12975-024-01320-2.
The Woven EndoBridge (WEB) device has become a prominent treatment for wide-neck bifurcation intracranial aneurysms since its FDA approval in 2018. However, the impact of anticoagulant therapy on its efficacy and patient outcomes remains underexplored. This study aims to evaluate the effects of postoperative anticoagulant use on aneurysm occlusion, retreatment rates, and functional outcomes following WEB device implantation. This retrospective multicenter study included 457 patients treated with the WEB device across 10 academic institutions in the United States between January 2012 and June 2024. Patients were categorized based on postoperative anticoagulant use: 91 patients (19.9%) received anticoagulants, while 366 patients (80.1%) did not. Propensity score matching (PSM) was employed to control for potential confounders, resulting in 316 matched patients (229 non-anticoagulant and 87 anticoagulant). After PSM, the anticoagulant group had lower rates of excellent functional outcomes (mRS 0-1: 73% vs. 85%, p = 0.026) and higher mortality rates (6.7% vs. 3.7%, p = 0.33), though the latter difference was not statistically significant. No significant differences in the last follow-up adequate occlusion were observed between the two groups (p = 0.7). However, patients in the anticoagulant group had lower major device compaction (> 50%) (4.9% vs. 12%, p = 0.12) and retreatment rates (4.6% vs. 12%, p = 0.045). Postoperative anticoagulant use is associated with poor functional outcomes and higher tendency for higher mortality rate. No significant differences in the last follow-up adequate occlusion rate were observed between the anticoagulant group and non-anticoagulant group. However, patients in the anticoagulant group had lower major compaction and retreatment rates. These findings suggest that the WEB mechanism of occlusion is more complex than what have been hypothesized and highlight the need for individualized management strategies to optimize outcomes in patients requiring anticoagulation post-WEB. Further studies are needed.
自2018年获得美国食品药品监督管理局（FDA）批准以来，编织型血管内桥接（WEB）装置已成为治疗宽颈分叉颅内动脉瘤的一种重要方法。然而，抗凝治疗对其疗效和患者预后的影响仍未得到充分研究。本研究旨在评估WEB装置植入术后使用抗凝剂对动脉瘤闭塞、再次治疗率和功能预后的影响。这项回顾性多中心研究纳入了2012年1月至2024年6月期间在美国10家学术机构接受WEB装置治疗的457例患者。根据术后抗凝剂的使用情况对患者进行分类：91例患者（19.9%）接受了抗凝治疗，而366例患者（80.1%）未接受抗凝治疗。采用倾向评分匹配（PSM）来控制潜在的混杂因素，最终得到316例匹配患者（229例未接受抗凝治疗，87例接受抗凝治疗）。PSM后，抗凝治疗组的良好功能预后率较低（改良Rankin量表评分0 - 1：73%对85%，p = 0.026），死亡率较高（6.7%对3.7%，p = 0.33），尽管后者差异无统计学意义。两组在末次随访时的充分闭塞率无显著差异（p = 0.7）。然而，抗凝治疗组患者的主要装置压实率（> 50%）较低（4.9%对12%，p = 0.12），再次治疗率也较低（4.6%对12%，p = 0.045）。术后使用抗凝剂与功能预后不良和较高的死亡率倾向相关。抗凝治疗组和未抗凝治疗组在末次随访时的充分闭塞率无显著差异。然而，抗凝治疗组患者的主要压实率和再次治疗率较低。这些发现表明，WEB装置的闭塞机制比之前假设的更为复杂，并强调需要个性化的管理策略来优化WEB术后需要抗凝治疗患者的预后。还需要进一步的研究。
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