破裂多重内动脉瘤的治疗策略和预后:来自多中心队列研究的见解
Xiuhu An1, Long Zhao2, Jingliang Su1
1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Neuroepidemiology
|October 2, 2025
概括
多重内动脉瘤 (MIA) 的一阶段治疗是可行的和安全的,与仅治疗负责动脉瘤相比,没有增加的风险. 患者选择是破裂MIA的最佳结果的关键.
科学领域:
- 神经外科 神经外科
- 血管神经学 血管神经学
- 干预性神经辐射学
背景情况:
- 多重内动脉瘤 (MIAs) 的最佳治疗方法仍在争论中.
- 破裂的MIA带来了复杂的管理挑战.
研究的目的:
- 为了比较一阶段治疗的临床结果与破裂MIA的选择性治疗.
- 为了确定破裂的MIA患者的死亡风险因素.
主要方法:
- 来自中国多中心脑动脉瘤数据库 (CMAD) 的811名破裂MIA患者的回顾性分析.
- 1:1倾向分数匹配 (PSM) 对632名患者 (316名单阶段,316名选择性治疗).
- 用于结果和生存分析的概括估计方程和考克斯比例危险模型.
主要成果:
- 一个阶段的治疗显示出较低的两年死亡率 (11.2%对16.2%) 的趋势,但没有统计学意义.
- 两组之间功能结果或住院并发症没有显著差异.
- 年龄,以前的中风和亨特-赫斯等级IV-V是独立的死亡风险因素;内血管治疗 (EVT) 有保护作用.
结论:
- 对破裂的MIA进行一阶段治疗是一种可行的选择,没有明显的过度风险.
- 精心选择患者对于成功管理至关重要.
- 确定死亡风险因素可以指导临床决策和预防策略.
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