远端前脑动脉动脉瘤内血管治疗的有效性:一个多中心观察性研究
Mariko Ishikawa1, Satoru Takahashi2, Sakyo Hirai2
1Department of Endovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan; Department of Neurosurgery, Ome Medical Center, Tokyo, Japan.
概括
内血管治疗 (EVT) 为远端前脑动脉 (DACA) 动脉瘤提供了微手术的替代方案,特别是未破裂的动脉瘤. 然而,EVT的复发率更高,特别是破裂动脉瘤,需要密切跟踪患者.
科学领域:
- 神经外科 神经外科
- 干预神经病学 干预神经病学
- 脑血管疾病 脑血管疾病
背景情况:
- 远端前脑动脉 (DACA) 动脉瘤是罕见的,占内动脉瘤的1%-9%.
- 微手术是标准的,但在解剖学上具有挑战性;内血管治疗 (EVT) 提供了一个不那么侵入性的替代方案.
- 对DACA动脉瘤微手术与EVT的临床结果进行比较对于治疗优化至关重要.
研究的目的:
- 为了比较微手术剪切和DACA动脉瘤内血管治疗 (EVT) 的临床结果.
- 评估EVT作为DACA动脉瘤治疗选择的疗效和安全性.
- 确定影响DACA动脉瘤管理治疗选择和结果的因素.
主要方法:
- 使用来自16个中风中心的多中心观察注册表.
- 分析了来自166名DACA动脉瘤患者的数据 (在2013-2021年期间治疗的4,552例内动脉瘤中).
- 患者接受了微手术剪切或EVT (线圈栓塞).
主要成果:
- 在未破裂 (10.5%对9.1%) 或破裂动脉瘤 (5.2%对6.9%) 中,微手术和EVT之间没有发现与并发症相关的发病率的显著差异.
- 与手术剪切相比,线圈栓塞的复发率和再治疗率显著更高,特别是在破裂动脉瘤 (2.6%对27.6%,p<0.01).
- 在两组治疗中,患者的特征是相似的.
结论:
- 对于DACA动脉瘤,EVT是微手术的可行的替代方案,特别是在未破裂的病例或不适合进行切割的患者中.
- 与EVT相关的更高的复发率和再治疗率,特别是破裂动脉瘤,需要仔细考虑和密切跟踪.
- 需要进一步的研究来完善EVT策略,并改善DACA动脉瘤的长期结果.
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