Dicpinigaitis Alis J, Singh Ravnit, Hirani Rahim, Shah Smit P, Mahmoud Noor A, Moeini Naghani Iman, Gandhi Chirag D, Al-Mufti Fawaz
Department of Neurology, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA.
School of Medicine, New York Medical College, Valhalla, NY, USA.
Interv Neuroradiol. 2025 Jun 20:15910199251351163. doi: 10.1177/15910199251351163.
IntroductionAlthough flow diversion (FD) has become a major treatment modality for unruptured intracranial aneurysms, it has been used as an off-label therapy for ruptured aneurysms whose morphologies or other characteristics may not be amenable to traditional coil embolization (CE). Previous literature has demonstrated high angiographic occlusion rates for FD in the acute setting, but also high rates of peri-procedural complications (some of which result from use of dual anti-platelet therapy).MethodsAneurysmal subarachnoid hemorrhage (aSAH) hospitalizations treated with endovascular therapy were identified in the National Inpatient Sample (NIS) in 2020. The primary exposure was treatment with FD (identified using a dedicated ICD-10-CM billing code specifying FD intraluminal device), and the primary endpoints were favorable outcome (defined by the NIS Subarachnoid Hemorrhage Outcome Measure, shown to have high concordance with modified Rankin Scale scores < 2 at 90 days following discharge) and peri-procedural ischemic and hemorrhagic complications (PPIHC). Endpoints were compared between FD and CE following 1:1 propensity score matching, adjusting for age, Hunt and Hess grade, comorbidity burden, and aneurysm location.Results7780 aSAH hospitalizations were identified, 150 (1.9%) of which documented treatment with FD, the remainder with CE. 16.7% of FD procedures were preceded by CE. Median treatment time with FD was admission day 1 (1-8) (IQR). Favorable outcomes were achieved in 46.7% of FD cases (and in 47.6% of CE cases), while PPIHC complications were seen in less than 3.3% of cases (and in 2.1% of CE cases). Following propensity score adjustment, 150 FD cases were matched to 150 CE cases, and rates of favorable outcome (46.7% vs. 50.0%, p = 0.563) and PPIHC (3.3% vs. 6.7%, p = 0.185) did not differ between the two treatment modalities.ConclusionFD demonstrated similar clinical outcomes and complication rates in comparison with CE for the treatment of ruptured aneurysms.
引言
尽管血流导向（FD）已成为未破裂颅内动脉瘤的主要治疗方式，但它一直被用作形态或其他特征可能不适合传统弹簧圈栓塞（CE）的破裂动脉瘤的非标签治疗方法。先前的文献表明，FD在急性期具有较高的血管造影闭塞率，但围手术期并发症发生率也较高（其中一些是由双联抗血小板治疗引起的）。
方法
在2020年的全国住院患者样本（NIS）中确定接受血管内治疗的动脉瘤性蛛网膜下腔出血（aSAH）住院病例。主要暴露因素是FD治疗（使用指定FD腔内装置的专用ICD-10-CM计费代码确定），主要终点是良好结局（由NIS蛛网膜下腔出血结局测量定义，显示与出院后90天改良Rankin量表评分<2高度一致）和围手术期缺血性和出血性并发症（PPIHC）。在1:1倾向评分匹配后，比较FD和CE之间的终点，调整年龄、Hunt和Hess分级、合并症负担和动脉瘤位置。
结果
共确定7780例aSAH住院病例，其中150例（1.9%）记录接受FD治疗，其余接受CE治疗。16.7%的FD手术之前进行过CE。FD的中位治疗时间为入院第1天（1-8）（四分位间距）。46.7%的FD病例（以及47.6%的CE病例）获得了良好结局，而PPIHC并发症在不到3.3%的病例中出现（以及2.1%的CE病例）。倾向评分调整后，150例FD病例与150例CE病例匹配，两种治疗方式的良好结局发生率（46.7%对50.0%，p = 0.563）和PPIHC发生率（3.3%对6.7%，p = 0.185）没有差异。
结论
在治疗破裂动脉瘤方面，与CE相比，FD显示出相似的临床结局和并发症发生率。
