Aburub Abdallah, Felber Stephan, Henkes Hans, Kemmling André, Forsting Michael, Nimsky Christopher, Ali Zakarya, Hajiyev Kamran, von Gottberg Philip, Almohammad Mohammad, Naziri Weis, Filioglo Andrei, Khanafer Ali
Department of Diagnostic and Interventional Neuroradiology, Philipps University of Marburg, Marburg, Germany.
Institute for Diagnostic and Interventional Radiology and Neuroradiology, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany.
Neuroradiology. 2025 Jul 21. doi: 10.1007/s00234-025-03715-w.
To evaluate the safety, efficacy, and clinical outcomes of stent-assisted coiling (SAC) and flow diversion (FD) with hydrophilic polymer-coated (HPC) devices under prasugrel single antiplatelet therapy (SAPT) in the treatment of acutely ruptured wide-neck intracranial aneurysms.
This multicenter retrospective case series included patients with ruptured saccular intracranial aneurysms treated through SAC or FD with HPC-coated devices under SAPT at four specialized neurovascular centers. Baseline demographics, aneurysm characteristics, procedural details, and clinical outcomes were analyzed. The primary outcomes included technical success, periprocedural complications, aneurysm occlusion rates at follow-up (FU), and functional outcomes assessed with the modified Rankin Scale (mRS).
A total of 46 patients were included (mean age 57.4 years). SAC and FD were performed in equal proportions. Technical success was achieved in 100% of cases. The immediate complete occlusion rate was significantly higher for SAC (95.7%) than FD (21.7%, p < 0.001). However, the occlusion rates at 12-month FU were comparable (SAC 100% vs. FD 95%, p = 0.364). The overall periprocedural complication rate was low (4.3%), and mortality before discharge was 10.9%. Favorable functional outcomes (mRS ≤ 2) at the last FU were achieved in 84% of patients, and no significant differences were observed between the SAC and FD groups.
SAC and FD with HPC-coated devices under prasugrel SAPT appeared to be safe and effective in treating ruptured wide-neck aneurysms. Whereas SAC achieved higher immediate occlusion rates, the long-term outcomes were comparable between groups. These findings support the feasibility of SAPT in this high-risk population and warrant further prospective validation.
评估在普拉格雷单抗单一抗血小板治疗（SAPT）下，使用亲水性聚合物涂层（HPC）装置进行支架辅助弹簧圈栓塞术（SAC）和血流导向术（FD）治疗急性破裂宽颈颅内动脉瘤的安全性、有效性及临床结果。
本多中心回顾性病例系列纳入了在四个专业神经血管中心接受SAC或FD联合HPC涂层装置及SAPT治疗的颅内囊状破裂动脉瘤患者。分析了基线人口统计学、动脉瘤特征、手术细节及临床结果。主要结果包括技术成功率、围手术期并发症、随访（FU）时的动脉瘤闭塞率以及用改良Rankin量表（mRS）评估的功能结果。
共纳入46例患者（平均年龄57.4岁）。SAC和FD的实施比例相同。所有病例均取得技术成功。SAC的即刻完全闭塞率（95.7%）显著高于FD（21.7%，p<0.001）。然而，12个月随访时的闭塞率相当（SAC为100%，FD为95%，p = 0.364）。总体围手术期并发症发生率较低（4.3%），出院前死亡率为10.9%。84%的患者在最后一次随访时获得了良好的功能结果（mRS≤2），SAC组和FD组之间未观察到显著差异。
在普拉格雷单抗SAPT下，使用HPC涂层装置进行SAC和FD在治疗破裂宽颈动脉瘤方面似乎是安全有效的。虽然SAC的即刻闭塞率较高，但两组的长期结果相当。这些发现支持了在这一高危人群中进行SAPT的可行性，并有待进一步的前瞻性验证。
