Li Gaozhi, Ding Shenghao, Wang Jiale, Zheng Kuang, Li Wenshuai, Mao Guohua, Liu Xiaobo, Zhang Zheming, Jin Dianshi, Liu Lang, Guo Qinhua, Liu Qingyuan, Zhang Xiaohua, Samaniego Edgar A, Du Rose, Pan Yaohua, Wan Jieqing, Zhao Bing
Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Int J Surg. 2025 Jun 1;111(6):3876-3885. doi: 10.1097/JS9.0000000000002357. Epub 2025 Mar 28.
Stent-assisted coiling (SAC) is a reasonable treatment for ruptured cerebral aneurysms that are not amenable to primary coiling. However, the safety and efficacy of SAC for acutely ruptured cerebral aneurysms need to be further determined.
To evaluate the safety and efficacy of SAC for acutely ruptured cerebral aneurysms.
This was a prospective, multicenter study of consecutive patients with acutely ruptured cerebral aneurysms treated with SAC within 72 hours after presentation. The primary outcome was treatment-related thromboembolic complications within 30 days of treatment; the secondary outcomes were hemorrhagic complications and aneurysm recurrence. A favorable clinical outcome was defined as a modified Rankin scale (mRS) of 0 to 2 at 6 months after treatment.
Of the 315 patients, 278 patients with 278 acutely ruptured aneurysms were included in the study. Treatment-related thromboembolic complications occurred in 32 patients (11.5%), including nine (3.2%) patients with intraoperative thrombosis and 23 (8.3%) patients with postoperative ischemia. Hemorrhagic complications occurred in 13 (4.7%) patients, including one (0.4%) patient with intraoperative hemorrhage and 12 (4.3%) patients with postoperative hemorrhage. Aneurysm rebleeding occurred in two (0.7%) patients. A total of 251 (251/275, 91.3%) patients had favorable clinical outcomes at the 6-month follow-up. The rate of aneurysm recurrence was 7.2%. Patients with a worse WFNS grade tended to have thromboembolic complications (21.2% vs. 10.2%, P = 0.079) and hemorrhagic complications (12.1% vs. 3.7%, P = 0.054). Treatment-related thromboembolic complications and hemorrhagic complications were independent predictors of unfavorable clinical outcomes.
Most patients had favorable clinical outcomes, with a low risk of intraoperative complications, aneurysm rebleeding, and a high rate of aneurysm occlusion. SAC for acutely ruptured aneurysms is a safe and effective procedure, especially in patients with good clinical conditions before treatment.
支架辅助弹簧圈栓塞术（SAC）是治疗无法进行初次弹簧圈栓塞的破裂性脑动脉瘤的一种合理方法。然而，SAC治疗急性破裂性脑动脉瘤的安全性和有效性仍需进一步确定。
评估SAC治疗急性破裂性脑动脉瘤的安全性和有效性。
这是一项前瞻性、多中心研究，纳入了连续的急性破裂性脑动脉瘤患者，这些患者在就诊后72小时内接受了SAC治疗。主要结局是治疗后30天内与治疗相关的血栓栓塞并发症；次要结局是出血并发症和动脉瘤复发。良好的临床结局定义为治疗后6个月改良Rankin量表（mRS）评分为0至2分。
315例患者中，278例患有278个急性破裂性动脉瘤的患者被纳入研究。32例患者（11.5%）发生了与治疗相关的血栓栓塞并发症，包括9例（3.2%）术中血栓形成患者和23例（8.3%）术后缺血患者。13例（4.7%）患者发生了出血并发症，包括1例（0.4%）术中出血患者和12例（4.3%）术后出血患者。2例（0.7%）患者发生了动脉瘤再出血。在6个月的随访中，共有251例（251/275，91.3%）患者获得了良好的临床结局。动脉瘤复发率为7.2%。WFNS分级较差的患者更容易发生血栓栓塞并发症（21.2%对10.2%，P = 0.079）和出血并发症（12.1%对3.7%，P = 0.054）。与治疗相关的血栓栓塞并发症和出血并发症是不良临床结局的独立预测因素。
大多数患者获得了良好的临床结局，术中并发症、动脉瘤再出血风险低，动脉瘤闭塞率高。SAC治疗急性破裂性动脉瘤是一种安全有效的方法，尤其是对于治疗前临床状况良好的患者。
