吸烟对采用编织型血管内桥接器治疗的宽颈颅内动脉瘤复发率的影响：一项多中心回顾性研究
Impact of smoking on recurrence rates among wide-neck intracranial aneurysms treated with Woven EndoBridge: a multicenter retrospective study.
作者信息
Vaishnav Dhrumil, Essibayi Muhammed Amir, Musmar Basel, Adeeb Nimer, Salim Hamza Adel, Aslan Assala, Cancelliere Nicole M, McLellan Rachel M, Algin Oktay, Ghozy Sherief, Lay Sovann V, Guenego Adrien, Renieri Leonardo, Carnevale Joseph, Saliou Guillaume, Mastorakos Panagiotis, El Naamani Kareem, 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, Ayberk Giyas, Celal Gunes Yasin, 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, Nguyen Anh, 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, Sheth Sunil A, Spiegel Gary, Tawk Rabih G, Lubicz Boris, Panni Pietro, Puri Ajit S, Pero Guglielmo, Nossek Erez, Raz Eytan, Killer-Oberpfalzer Monika, Griessenauer Christoph J, Asadi Hamed, Siddiqui Adnan, Brook Allan L, Haranhalli Neil, 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, Mendes Pereira Vitor, Patel Aman B, Altschul David J, Dmytriw Adam A
机构信息
1Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
3Department of Neurosurgery, Louisiana State University, Shreveport, Louisiana.
出版信息
J Neurosurg. 2025 Jan 31;142(6):1732-1740. doi: 10.3171/2024.10.JNS241058. Print 2025 Jun 1.
OBJECTIVE
Tobacco smoking is among the factors known to significantly augment the risk of untreated intracranial aneurysm (IA) growth and rupture. Smoking appears to have a variable effect on different endovascular treatment modalities. The impact of smoking on the safety, efficacy, and outcomes of Woven EndoBridge (WEB) device use for wide-neck IAs has not been evaluated. This study aimed to investigate the outcomes of WEB devices by smoking status.
METHODS
A retrospective multicenter analysis was conducted on the data of patients from 36 sites worldwide treated with the WEB device for intracranial saccular aneurysms. Patients were stratified based on smoking status (current, former, and never smokers). The Student t-test and chi-square test were performed for continuous and categorical variables, respectively. Multivariable logistic regression was used to adjust for confounders.
RESULTS
Of 1376 patients with available smoking status, 504 were current smokers, 358 were former smokers, and 514 were never smokers. Upon adjusting for significant confounders, no association was found between smoking and recurrence outcomes (OR 1.39, 95% CI 0.69-2.80; p = 0.36), thromboembolic and hemorrhagic complications, and mortality among IAs treated with the WEB device. There was no statistically significant difference in outcomes between former and never smokers (OR 1.23, 95% CI 0.70-2.18; p = 0.46). The location of aneurysms differed between smoking groups, with former smokers having more anterior circulation aneurysms compared with current and never smokers (99.0% vs 96.9% vs 95.3%; p = 0.01). In terms of clinical symptoms, headache and dizziness were more common in the never smokers compared with current and former smokers (13.9% vs 8.9% vs 7.7%, p = 0.01).
CONCLUSIONS
This large-scale study suggests no significant correlation between smoking and the recurrence of IAs treated with the WEB device. Biological studies are warranted to better understand the biological impact of smoking on the growth and rupture of treated IAs.
目的
吸烟是已知会显著增加未治疗颅内动脉瘤（IA）生长和破裂风险的因素之一。吸烟似乎对不同的血管内治疗方式有不同的影响。吸烟对用于宽颈IA的编织型血管内桥接（WEB）装置的安全性、有效性和治疗结果的影响尚未得到评估。本研究旨在按吸烟状况调查WEB装置的治疗结果。
方法
对全球36个地点接受WEB装置治疗颅内囊状动脉瘤的患者数据进行回顾性多中心分析。患者根据吸烟状况（当前吸烟者、既往吸烟者和从不吸烟者）进行分层。分别对连续变量和分类变量进行Student t检验和卡方检验。使用多变量逻辑回归来调整混杂因素。
结果
在1376名有可用吸烟状况的患者中，504名是当前吸烟者，358名是既往吸烟者，514名是从不吸烟者。在调整了显著的混杂因素后，未发现吸烟与接受WEB装置治疗的IA的复发结果（比值比1.39，95%置信区间0.69 - 2.80；p = 0.36）、血栓栓塞和出血并发症以及死亡率之间存在关联。既往吸烟者和从不吸烟者在治疗结果上没有统计学上的显著差异（比值比1.23，95%置信区间0.70 - 2.18；p = 0.46）。吸烟组之间动脉瘤的位置有所不同，与当前吸烟者和从不吸烟者相比，既往吸烟者的前循环动脉瘤更多（99.0%对96.9%对95.3%；p = 0.01）。在临床症状方面，从不吸烟者比当前吸烟者和既往吸烟者更常见头痛和头晕（13.9%对8.9%对7.7%，p = 0.01）。
结论
这项大规模研究表明，吸烟与接受WEB装置治疗的IA复发之间无显著相关性。有必要进行生物学研究，以更好地了解吸烟对治疗后IA生长和破裂的生物学影响。
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