Benefits of Surgical Treatment for Unruptured Intracranial Aneurysms in Elderly Patients

Objective

Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients.

Methods

We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only).

Results

Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate.

Conclusion

Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.     

血管内治疗床突旁未破裂颅内动脉瘤的疗效分析

目的 评估血管内治疗床突旁未破裂颅内动脉瘤(unruptured intracranial aneurysm,UIA)的安全性和有效性.方法 回顾性纳入2017年1月-2019年12月于空军军医大学唐都医院神经外科连续收治的床突旁UIA患者.收集患者的基线资料和影像学资料,统计动脉瘤栓塞结果、围手术期并发症发生情况及预...     

The Merits of Endovascular Coil Surgery for Patients with Unruptured Intracranial Aneurysms

Objective

The purpose of this study was to report the morbidity, mortality, angiographic results, and merits of elective coiling of unruptured intracranial aneurysms.

Methods

Ninety-six unruptured aneurysms in 92 patients were electively treated with detachable coils. Eighty-one of these aneurysms were located in the anterior circulation, and 15 were located in the posterior circulation. Thirty-six aneurysms were treated in the presence of previously ruptured aneurysms that had already undergone operation. Nine unruptured aneurysms presented with symptoms of mass effect. The remaining 51 aneurysms were incidentally discovered in patients with other cerebral diseases and in individuals undergoing routine health maintenance. Angiographic and clinical outcomes and procedure-related complications were analyzed.

Results

Eight procedure-related untoward events (8.3%) occurred during surgery or within procedure-related hospitalization, including thromboembolism, sac perforation, and coil migration. Permanent procedural morbidity was 2.2% ; there was no mortality. Complete occlusion was achieved in 73 (76%) aneurysms, neck remnant occlusion in 18 (18.7%) aneurysms, and incomplete occlusion in five (5.2%) aneurysms. Recanalization occurred in 8 (15.4%) of 52 coiled aneurysms that were available for follow-up conventional angiography or magnetic resonance angiography over a mean period of 13.3 months. No ruptures occurred during the follow-up period (12-79 months).

Conclusion

Endovascular coil surgery for patients with unruptured intracranial aneurysms is characterized by low procedural mortality and morbidity and has advantages in patients with poor general health, cerebral infarction, posterior circulation aneurysms, aneurysms of the proximal internal cerebral artery, and unruptured aneurysms associated with ruptured aneurysm. For the management of unruptured aneurysms, endovascular coil surgery is considered an attractive alterative option.     

Unruptured Intracranial Aneurysms with Oculomotor Nerve Palsy : Clinical Outcome between Surgical Clipping and Coil Embolization

Objective

To evaluate the clinical outcome of coil embolization for unruptured intracranial aneurysm (UIA) with oculomotor nerve palsy (ONP) compared with surgical clipping.

Methods

A total of 19 patients presented with ONP caused by UIAs between Jan 2004 and June 2008. Ten patients underwent coil embolization and nine patients surgical clipping. The following parameters were retrospectively analyzed to evaluate the differences in clinical outcome observed in both coil embolization and surgical clipping : 1) gender, 2) age, 3) location of the aneurysm, 4) duration of the symptom, and 5) degree of ONP.

Results

Following treatment, complete symptomatic recovery or partial relief from ONP was observed in 15 patients. Seven of the ten patients were treated by coil embolization, compared to eight of the nine patients treated by surgical clipping (p = 0.582). Patient''s gender, age, location of the aneurysm, size of the aneurysm, duration of symptom, and degree of the ONP did not statistically correlate with recovery of symptoms between the two groups. No significant differences were observed in mean improvement time in either group (55 days in coil embolization and 60 days in surgical clipping).

Conclusion

This study indicates that no significant differences were observed in the clinical outcome between coil embolization and surgical clipping techniques in the treatment of aneurysms causing ONP. Coil embolization seems to be more feasible and safe treatment modality for the relief and recovery of oculomotor nerve palsy.     

277例颅内动脉瘤的显微外科手术治疗

目的探讨颅内动脉瘤的手术策略、术中脑保护以及疗效等。方法采用夹闭、切除、孤立、包裹等方法手术处理277例共312个动脉瘤。其中在低温停循环条件下手术夹闭5例,行动脉瘤孤立3例,行动脉瘤包裹2例。结果277例中,127例术后行DSA检查,绝大多数动脉瘤夹闭满意。按GOS标准,良好243例(87.7%),差13例,死亡21例。189例得以随访,恢复良好180例(95.2%),中残或重残7例,死亡2例。结论手术夹闭是治疗动脉瘤的确实有效的方法。对复杂性颅内动脉瘤,需采用充分的显露,血管临时阻断,有效的脑保护,动脉瘤切开减压,缩窄瘤颈瘤体成型或载瘤动脉的塑型等措施,方能达到满意的手术效果。     

Angiographic Results of Wide-Necked Intracranial Aneurysms Treated with Coil Embolization : A Single Center Experience

Objective

Endovascular treatment of wide-necked intracranial aneurysms is a challenge and the durability and the safety of these treated aneurysms remain unknown. The aim of this study was to evaluate the clinical and long-term angiographic results of wide-necked intracranial aneurysms treated with coil embolization.

Methods

Between January 2002 and December 2012, 53 wide-necked aneurysms treated with coil embolization were selected. Forty were female, and 13 were male. Twenty eight (52.8%) were ruptured aneurysms, and 25 (47.2%) were unruptured aneurysms. The patents'' medical and radiological records were reviewed retrospectively.

Results

Of the 53 aneurysms, coiling alone was employed in 45 (84.9%) and stent-assisted coiling was done in 8 (15.1%). The initial angiographic results revealed Raymond class 1 (complete occlusion) in 30 (56.6%) cases, Raymond class 2 (residual neck) in 18 (34.0%) cases, and Raymond class 3 (residual sac) in 5 (9.4%) cases. The mean angiographic follow-up period was 37.9 months (12-120 months). At the last angiographies, Raymond class 1 was seen in 26 (49.1%) cases, Raymond class 2 in 16 (30.2%), and Raymond class 3 in 11 (20.8%). Angiographic recurrence occurred in 22 (41.5%) patients, with minor recurrence in 7 (13.2%) cases and major recurrence in 15 (28.3%). Retreatment was performed in 8 cases (15.1%). A suboptimal result on the initial angiography was a significant predictor of recurrence in this study (p=0.03).

Conclusion

The predictor of recurrence in wide-necked aneurysms is a suboptimal result on the initial angiography. Long-term angiographic follow-up is recommended in wide-necked aneurysms.     

颅内外动脉狭窄合并颅内无症状动脉瘤的血管内治疗策略研究

目的 探索颅内外动脉狭窄合并颅内无症状动脉瘤的安全和有效的血管内治疗策略。 方法 回顾性分析北京天坛医院急诊介入科2012年9月～2013年8月收住的因颅内外动脉狭窄拟行支 架治疗且合并颅内无症状动脉瘤的患者26例。对其临床、影像学资料、治疗措施及结果、并发症及预 后等进行分析。 结果 26例患者共发现≥70%的狭窄或闭塞病变54处,动脉瘤30枚（非同流域16枚,狭窄后7枚,狭窄 处3枚,狭窄前4枚）。26例患者中21例实施了狭窄病变的支架置入术,共干预25个狭窄/闭塞病变,技 术成功率100%。选择个体化的动脉瘤干预措施：16例患者的17枚动脉瘤（非同流域、直径＜5 mm、 夹层）建议随访观察;2例患者的2枚动脉瘤（直径＞5 mm、形状不规则）择期行栓塞术;5例患者的 6枚动脉瘤（狭窄后、狭窄处、多发性、直径＞5 mm、后交通段）同期行栓塞术或支架覆盖;3例患者 的5枚动脉瘤（狭窄后、分叶状、多发性、直径＞5 mm）建议介入治疗但因家属拒绝手术等原因选择随 访观察。术后发生脑室出血1例。临床随访10～21个月,所有患者均预后良好,仅发现无症状性支架内 再狭窄1例。 结论 颅内外动脉狭窄合并颅内无症状动脉瘤时根据动脉瘤与狭窄病变的位置关系,动脉瘤大小、 形态、位置、数量和患者情况等综合分析后给予个体化血管内治疗安全、有效。     

Comparative Cost Analysis for Surgical and Endovascular Treatment of Unruptured Intracranial Aneurysms in South Korea

Objective

A cost comparison of the surgical clipping and endovascular coiling of unruptured intracranial aneurysms (UIAs), and the identification of the principal cost determinants of these treatments.

Methods

This study conducted a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of UIAs between January 2011 and May 2014. The medical records, radiological data, and hospital cost data were all examined.

Results

When comparing the total hospital costs for surgical clipping of a single UIA (n=188) and endovascular coiling of a single UIA (n=188), surgical treatment [mean±standard deviation (SD) : ₩8,280,000±1,490,000] resulted in significantly lower total hospital costs than endovascular treatment (mean±SD : ₩11,700,000±3,050,000, p<0.001). In a multi regression analysis, the factors significantly associated with the total hospital costs for endovascular treatment were the aneurysm diameter (p<0.001) and patient age (p=0.014). For the endovascular group, a Pearson correlation analysis revealed a strong positive correlation (r=0.77) between the aneurysm diameter and the total hospital costs, while a simple linear regression provided the equation, y (₩)=6,658,630+855,250x (mm), where y represents the total hospital costs and x is the aneurysm diameter.

Conclusion

In South Korea, the total hospital costs for the surgical clipping of UIAs were found to be lower than those for endovascular coiling when the surgical results were favorable without significant complications. Plus, a strong positive correlation was noted between an increase in the aneurysm diameter and a dramatic increase in the costs of endovascular coiling.     

比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤安全性和有效性的Meta分析

目的比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤的安全性和有效性。方法计算机检索1990至2018年颅内未破裂动脉瘤的所有临床对照研究。两名研究员分别纳入研究、提取数据、质量评价并应用Rev Man5. 0软件进行数据处理。结果最终纳入21篇文献,病例数109114例。Meta分析结果提示:手术夹闭组动脉瘤闭塞率为88. 2%,平均住院时间7. 7天,均高于介入栓塞组的65. 3%和4. 1天,P 0. 05。介入组患者的短期死亡率和致残率分别为0. 61%和2. 1%,均低于手术组的1. 27%和4. 7%,P 0. 05。介入组患者的1年期死亡率和致残率(2. 5%、2. 5%)均与手术组(2. 2%、1. 8%)无明显差异,P 0. 05。漏斗图未发现发表偏倚。敏感性分析结果一致。结论介入栓塞相比于手术夹闭可缩短患者的住院时间,降低患者的短期不良预后发生率。但是动脉瘤的闭塞率较低,1年期预后与手术夹闭无明显差异。据此推测手术夹闭患者的长期预后可能要好于介入栓塞,手术夹闭更适合于年轻患者。     

高压氧治疗未破裂颅内动脉瘤夹闭术后脑梗死疗效及影响因素分析

目的 探讨高压氧治疗未破裂颅内动脉瘤夹闭术后脑梗死疗效及影响因素。
方法 回顾性纳入未破裂颅内动脉瘤夹闭术后脑梗死患者，根据是否进行高压氧治疗（压力
0.2 Mpa，稳压60 min，每日1次）分为高压氧组和对照组。应用NIHSS评分评估患者出院时神经功能缺
损程度，观察高压氧治疗是否有效。将出院NIHSS评分较脑梗死发病24 h内评分下降≥4分作为治疗显
效的标准，应用多因素Logistic回归分析，探讨术后脑梗死疗效的影响因素。
结果 共纳入56例患者，平均年龄53.63±11.02岁，其中男性24例（42.9%）。高压氧组41例，对照
组15例。高压氧组出院NIHSS评分低于对照组[6（4～8）分 vs 12（7～15）分，P =0.001]。纳入患者中治
疗显效22例（39.3%），多因素Logistic回归分析显示，脑梗死发病24 h内NIHSS评分高（OR 1.411，95%CI
1.134～1.756，P =0.002）是未破裂动脉瘤术后脑梗死治疗显效的独立影响因素；与未行高压氧治
疗对比，高压氧治疗1～5次（OR 16.454，95%CI 1.326～204.191，P =0.029），高压氧治疗6～9次（OR
20.966，95%CI 1.996～220.253，P =0.011），高压氧治疗≥10次（OR 47.026，95%CI 3.651～605.774，
P =0.003）与术后脑梗死治疗显效呈独立正相关。
结论 高压氧治疗颅内动脉瘤夹闭术后脑梗死有效，脑梗死发病24 h内NIHSS评分及高压氧治疗是
未破裂颅内动脉瘤术后脑梗死治疗显效独立影响因素。     

高压氧治疗未破裂颅内动脉瘤夹闭术后脑梗死疗效及影响因素分析

目的 探讨高压氧治疗未破裂颅内动脉瘤夹闭术后脑梗死疗效及影响因素。 方法 回顾性纳入未破裂颅内动脉瘤夹闭术后脑梗死患者,根据是否进行高压氧治疗（压力 0.2 Mpa,稳压60 min,每日1次）分为高压氧组和对照组。应用NIHSS评分评估患者出院时神经功能缺 损程度,观察高压氧治疗是否有效。将出院NIHSS评分较脑梗死发病24 h内评分下降≥4分作为治疗显 效的标准,应用多因素Logistic回归分析,探讨术后脑梗死疗效的影响因素。 结果 共纳入56例患者,平均年龄53.63±11.02岁,其中男性24例（42.9%）。高压氧组41例,对照 组15例。高压氧组出院NIHSS评分低于对照组[6（4～8）分 vs 12（7～15）分,P =0.001]。纳入患者中治 疗显效22例（39.3%）,多因素Logistic回归分析显示,脑梗死发病24 h内NIHSS评分高（OR 1.411,95%CI 1.134～1.756,P =0.002）是未破裂动脉瘤术后脑梗死治疗显效的独立影响因素;与未行高压氧治 疗对比,高压氧治疗1～5次（OR 16.454,95%CI 1.326～204.191,P =0.029）,高压氧治疗6～9次（OR 20.966,95%CI 1.996～220.253,P =0.011）,高压氧治疗≥10次（OR 47.026,95%CI 3.651～605.774, P =0.003）与术后脑梗死治疗显效呈独立正相关。 结论 高压氧治疗颅内动脉瘤夹闭术后脑梗死有效,脑梗死发病24 h内NIHSS评分及高压氧治疗是 未破裂颅内动脉瘤术后脑梗死治疗显效独立影响因素。     

不同介入方法治疗颅内大型或巨大型动脉瘤的单中心经验

目的 评价不同介入方法治疗颅内大型或巨大型动脉瘤的有效性、并发症发生率以及预后情况。 方法 回顾性分析第二军医大学附属长海医院神经外科自2001年1月～2010年12月采用不同介入方法治疗的134例颅内大型或巨大型动脉瘤患者的临床资料,按患者接受介入治疗方法不同分为4组,其中载瘤动脉闭塞术11例,单纯弹簧圈栓塞20例,支架辅助下弹簧圈栓塞78例,血流导向装置治疗25例,随访时间6～44个月。影像学结果依据改良Raymond评分,临床症状依据改良Rankin量表（modified Rankin Scale,mRS）评分系统评价,分别评价4组患者出院时的预后良好率、末次随访时动脉瘤的治愈率、复发率,预后良好率及手术并发症情况。 结果 载瘤动脉闭塞组出院时的预后良好率是100%,单纯弹簧圈栓塞组为70%,支架辅助弹簧圈组为91%,而血流导向装置组为100%,四组间差异具有显著性（P=0.0030）。载瘤动脉闭塞组末次随访时治愈率是63.6%,单纯弹簧圈栓塞组为5.6%,支架辅助弹簧圈组为37.2%,而血流导向装置组为72%,四组间差异具有显著性（P=0.0002）。载瘤动脉闭塞组末次随访时的复发率为0%,单纯弹簧圈栓塞组为83.3%,支架辅助弹簧圈组为30.8%,而血流导向装置组为0%,四组间差异具有显著性（P＜0.0001）。载瘤动脉闭塞组末次随访时预后良好率为100%,单纯弹簧圈组为75%,支架辅助弹簧圈组为90%,血流导向装置组为100%,四组间差异具有显著性（P=0.0209）。载瘤动脉闭塞组并发症发生率为27.3%,单纯弹簧圈组为30%,支架辅助弹簧圈组为14.1%,血流导向装置组为0%,四组间差异无显著性（P=0.0650）。 结论 在颅内大型或巨大型动脉瘤的介入治疗中,单纯弹簧圈栓塞复发率高,支架辅助弹簧圈栓塞可降低复发率,载瘤动脉闭塞组预后良好率及复发率满意,但并发症发生率偏高,血流导向装置的初步临床结果令人满意。     

影响颅内破裂动脉瘤手术预后的相关因素分析

目的：探讨影响颅内破裂动脉瘤手术预后的相关因素。方法：应用SAS统计分析软件回顾性分析我院2007年1月1日至12月31日收冶的147例手术夹闭颅内破裂动脉瘤患者的临床资料。对可能影响患者预后的因素进行分析。结果：患者术前Hunt—Hess分级是影响预后最重要的因素，年龄也成为影响手术预后的重要因素。性别、术前CT提示有无脑内血肿、动脉瘤部位和大小、是否多发动脉瘤及术中动脉瘤是否破裂对预后影响无统计学意义。结论：患者术前Hunt—Hess分级越高，手术预后越差；年龄越大手术预后也越差。明确影响破裂动脉瘤手术预后的因素，有助于把握手术适应证并采取相应的措施，改善动脉瘤患者预后。     

Natural History of Unruptured Intracranial Aneurysms : A Retrospective Single Center Analysis

Objective

We conducted a retrospective cohort study to elucidate the natural course of unruptured intracranial aneurysms (UIAs) at a single institution.

Methods

Data from patients diagnosed with UIA from March 2000 to May 2008 at our hospital were subjected to a retrospective analysis. The cumulative and annual aneurysm rupture rates were calculated. Additionally, risk factors associated with aneurysmal rupture were identified.

Results

A total of 1339 aneurysms in 1006 patients met the inclusion criteria. During the follow-up period, 685 aneurysms were treated before rupture via either an open surgical or endovascular procedure. Six hundred fifty-four UIAs were identified and not repaired during the follow-up period. The mean UIA size was 4.5±3.2 mm, and 86.5% of the total UIAs had a largest dimension <7 mm. Among these UIAs, 18 ruptured at a median of 1.6 years (range : 27 days to 9.8 years) after day 0. The annual rupture risk during a 9-year follow-up was 1.00%. A multivariate Cox proportional hazards analysis revealed that the aneurysm size and a history of subarachnoid hemorrhage (SAH) were statistically significant risk factors for rupture. For an aneurysms smaller than 7 mm in the absence of a history of SAH, the annual rupture risk was 0.79%.

Conclusion

In our study, the annual rupture risk for UIAs smaller than 7 mm in the absence of a history of SAH was higher than that of Western populations but similar to that of the Japanese population.     

Recent Trends in Electively Treated Unruptured Intracranial Aneurysms

Background and Purpose: To determine recent treatment and outcome trends in patients undergoing elective surgical clipping (SC) or endovascular therapy (EVT) for unruptured intracranial aneurysms (UIAs) in the United States. Methods: Data were extracted and analyzed from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality for all patients admitted for elective EVT or SC of UIAs between 2011 and 2014. Treatment trends, in-hospital mortality, complication rates, length of stay (LOS) and total hospital costs were evaluated and analyzed. Results: A total of 31,070 patients with UIAs were included in our analysis, of which 14,411 and 16,659 underwent elective SC and EVT, respectively. There was no significant difference in in-hospital mortality rates between the 2 groups. EVT was associated with lower in-hospital complication rates, decreased median LOS (.8 days versus 3.3 days, P ≤ .0001), and an increased likelihood of discharge to home (92.9% versus 72.9%, P = .0001). Median total hospital charges were similar in both treatment cohorts. Independent predictors of mortality in the elective population were age over 40 years (P ≤ .0001), weekend treatment (P ≤ .0001), and high co-morbidity status (P ≤ .0001). Conclusions: In-hospital mortality rates were similar in elective EVT and SC UIA patients; however, EVT was associated with lower in-hospital complication rates and shorter LOS.     

Incidence and Risk Factors of Chronic Subdural Hematoma after Surgical Clipping for Unruptured Anterior Circulation Aneurysms

Objective

Chronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery. The purpose of this study was to identify the incidence and risk factors of postoperative CSDH after surgical clipping for unruptured anterior circulation aneurysms.

Methods

This retrospective study included 518 patients from a single tertiary institute from January 2008 to December 2013. CSDH was defined as subdural hemorrhage which needed surgical treatment. The degree of brain atrophy was estimated using the bicaudate ratio (BCR) index. We used uni- and multivariate analyses to identify risk factors correlated with CSDH.

Results

Sixteen (3.1%) patients experienced postoperative CSDH that required burr hole drainage surgery. In univariate analyses, male gender (p<0.001), size of aneurysm (p=0.030), higher BCR index (p=0.004), and the use of antithrombotic medication (p=0.006) were associated with postoperative CSDH. In multivariate analyses using logistic regression test, male gender [odds ratio (OR) 4.037, range 1.287-12.688], high BCR index (OR 5.376, range 1.170-25.000), and the use of antithrombotic medication (OR 4.854, range 1.658-14.085) were associated with postoperative CSDH (p<0.05). Postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study.

Conclusion

The incidence of CSDH was 3.1% in unruptured anterior circulation aneurysm surgery. This study shows that male gender, degree of brain atrophy, and the use of antithrombotic medication were associated with postoperative CSDH.     

Superciliary Keyhole Approach for Unruptured Anterior Circulation Aneurysms: Surgical Technique,Indications, and Contraindications

Neurosurgeons have been trying to reduce surgical invasiveness by applying minimally invasive keyhole approaches. Therefore, this paper clarifies the detailed surgical technique, its limitations, proper indications, and contraindications for a superciliary keyhole approach as a minimally invasive modification of a pterional approach. Successful superciliary keyhole surgery for unruptured aneurysms requires an understanding of the limitations and the use of special surgical techniques. Essentially, this means the effective selection of surgical indications, usage of the appropriate surgical instruments with a tubular shaft, and refined surgical techniques, including straightforward access to the aneurysm, clean surgical dissection, and the application of clips with an appropriate configuration. A superciliary keyhole approach allows unruptured anterior circulation aneurysms to be clipped safely, rapidly, and less invasively on the basis of appropriate surgical indications.     

649例动脉瘤的治疗经验

目的 探讨颅内动脉瘤患病的危险因素,无症状动脉瘤治疗方法 的选择.方法 回顾性分析649例颅内动脉瘤的临床资料,其中535例(82.4%)行动脉瘤蒂夹闭术,动脉瘤孤立术19例(2.9%),包裹术17例(2.6%),血管内治疗46例(7.1%),32例(5%)无症状病例未予特殊治疗,仅随诊.结果 术后12例死亡,手术死亡率1.9%.动脉瘤的后天患病的危险因素包括高血压、女性、高龄、吸烟.结论 动脉瘤的后天患病危险凶素包括高血压、女性、高龄以及吸烟.对于部分无症状动脉瘤无需治疗,随诊是其合适的选择.     

Outcomes of Stent-Assisted Coiling Using the Neuroform Atlas Stent in Unruptured Wide-Necked Intracranial Aneurysms

ObjectiveAlthough stent-assisted coiling (SAC) has been reported to be safe and effective in treating wide-necked aneurysms, the technique has procedure-related complications. Thus, we reported our experiences of SAC using the Neuroform Atlas stent in treating wide-necked aneurysms and evaluated the incidence of and risk factors for procedure-related complications. MethodsFrom March 2018 to August 2019, we treated 130 unruptured wide-necked aneurysms in 123 patients with Neuroform Atlas stents. Angiographic results and clinical outcomes were reviewed retrospectively. Clinical and angiographic follow-up were performed in all cases (mean, 12.4 months) after the procedure. ResultsThere were eight cases (6.2%) of procedure-related complications (two dissections, five thromboembolisms, and one hemorrhage) and two (1.5%) of delayed complications (one ischemia and one hemorrhage). There was one case (0.8%) of failure of stent deployment and one (0.8%) of suboptimal positioning of the stent. Follow-up angiography showed complete obliteration in 103 (79.2%), residual neck in 16 (12.3%), and residual aneurysm in 11 cases (8.5%). Aneurysm locations in the middle cerebral artery (odds ratio [OR], 2.211; p=0.046) and the anterior communicating artery (OR, 2.850; p=0.039) were associated with procedure-related complications on univariate analysis. However, no independent risk factor for procedure-related complications was noted in multivariate analysis. ConclusionThe Neuroform Atlas showed a high rate of technical success. Good clinical and radiographic outcomes in early follow-up suggests that the device is feasible and safe. SAC of aneurysms on the middle cerebral artery or anterior communicating artery may require more attention to prevent possible procedure-related complications.