Abstract：
OBJECTIVE: Despite growing evidence for the effectiveness of stent-assisted coil embolization (SAC) in treating acutely ruptured aneurysms, the safety of stent placement in acute phase remains controversial because of concerns for stent-induced thromboembolism and hemorrhagic events attributable to the necessity of antiplatelet therapy. Therefore, we investigated the safety and efficacy of SAC with periprocedural dual antiplatelet therapy (DAPT) compared with the coiling-only technique to determine whether it is a promising treatment strategy for ruptured aneurysms.
METHODS: We retrospectively evaluated 203 enrolled patients with acutely ruptured aneurysms, categorizing them into two groups: SAC and coiling-only groups. Comparative analyses between the two groups regarding angiographic results, clinical outcomes, and procedure-related complications were performed. A subgroup analysis of procedural complications was conducted on patients who did not receive chronic antithrombotic medications to alleviate their influence before hospitalization.
RESULTS: 130 (64.0%) patients were treated using the coiling-only technique, whereas 73 (36.0%) underwent SAC. There was a trend to a higher complete obliteration rate (p = 0.061) and significantly lower recanalization rate (p = 0.030) at angiographic follow-up in the SAC group compared to the coiling-only group. Postprocedural cerebral infarction occurred less frequently in the SAC group (8.2%) than in the coiling-only group (17.7%), showing a significant difference (p = 0.044). Although the ventriculostomy-related hemorrhage rate was significantly higher in the SAC group than in the coiling-only group (26.2% vs. 9.3%, p = 0.031), the incidence of symptomatic ventriculostomy-related hemorrhage was comparable. Subgroup analysis excluding patients receiving chronic antithrombotic medications showed similar results.
CONCLUSIONS: SAC with periprocedural DAPT could be a safe and effective treatment strategy for acutely ruptured aneurysms. Moreover, it might have a protective effect on postprocedural cerebral infarction without increasing the risk of symptomatic hemorrhagic complications.
METHODS: We retrospectively evaluated 203 enrolled patients with acutely ruptured aneurysms, categorizing them into two groups: SAC and coiling-only groups. Comparative analyses between the two groups regarding angiographic results, clinical outcomes, and procedure-related complications were performed. A subgroup analysis of procedural complications was conducted on patients who did not receive chronic antithrombotic medications to alleviate their influence before hospitalization.
RESULTS: 130 (64.0%) patients were treated using the coiling-only technique, whereas 73 (36.0%) underwent SAC. There was a trend to a higher complete obliteration rate (p = 0.061) and significantly lower recanalization rate (p = 0.030) at angiographic follow-up in the SAC group compared to the coiling-only group. Postprocedural cerebral infarction occurred less frequently in the SAC group (8.2%) than in the coiling-only group (17.7%), showing a significant difference (p = 0.044). Although the ventriculostomy-related hemorrhage rate was significantly higher in the SAC group than in the coiling-only group (26.2% vs. 9.3%, p = 0.031), the incidence of symptomatic ventriculostomy-related hemorrhage was comparable. Subgroup analysis excluding patients receiving chronic antithrombotic medications showed similar results.
CONCLUSIONS: SAC with periprocedural DAPT could be a safe and effective treatment strategy for acutely ruptured aneurysms. Moreover, it might have a protective effect on postprocedural cerebral infarction without increasing the risk of symptomatic hemorrhagic complications.
摘要：
目的：尽管越来越多的证据表明支架辅助弹簧圈栓塞（SAC）治疗急性破裂动脉瘤的有效性，急性期支架置入术的安全性仍存在争议,原因是人们担心支架诱发的血栓栓塞和出血事件,原因是需要进行抗血小板治疗.因此,我们研究了SAC联合围手术期双重抗血小板治疗(DAPT)的安全性和有效性,并与仅卷绕技术进行了比较,以确定SAC是否是破裂动脉瘤的有希望的治疗策略.
方法：我们回顾性评估了203例急性破裂动脉瘤患者，将它们分为两组：SAC和仅卷绕组。两组之间关于血管造影结果的比较分析，临床结果，和手术相关的并发症。对住院前未接受慢性抗血栓药物治疗的患者进行手术并发症的亚组分析，以减轻其影响。
结果：130（64.0％）患者使用仅卷绕技术进行治疗，73例（36.0％）接受了SAC。在血管造影随访中，与仅卷绕组相比，SAC组有更高的完全闭塞率（p=0.061）和显着更低的再通率（p=0.030）的趋势。术后脑梗死在SAC组(8.2%)的发生率低于仅卷绕组(17.7%),显示显著差异(p=0.044)。尽管SAC组的脑室造瘘术相关出血率明显高于仅卷绕组（26.2％vs.9.3%,p=0.031),有症状的脑室造瘘术相关出血的发生率相当.不包括接受慢性抗血栓药物治疗的患者的亚组分析显示了相似的结果。
结论：SAC联合围手术期DAPT可能是急性破裂动脉瘤安全有效的治疗策略。此外，它可能对术后脑梗死有保护作用,而不会增加症状性出血性并发症的风险.
方法：我们回顾性评估了203例急性破裂动脉瘤患者，将它们分为两组：SAC和仅卷绕组。两组之间关于血管造影结果的比较分析，临床结果，和手术相关的并发症。对住院前未接受慢性抗血栓药物治疗的患者进行手术并发症的亚组分析，以减轻其影响。
结果：130（64.0％）患者使用仅卷绕技术进行治疗，73例（36.0％）接受了SAC。在血管造影随访中，与仅卷绕组相比，SAC组有更高的完全闭塞率（p=0.061）和显着更低的再通率（p=0.030）的趋势。术后脑梗死在SAC组(8.2%)的发生率低于仅卷绕组(17.7%),显示显著差异(p=0.044)。尽管SAC组的脑室造瘘术相关出血率明显高于仅卷绕组（26.2％vs.9.3%,p=0.031),有症状的脑室造瘘术相关出血的发生率相当.不包括接受慢性抗血栓药物治疗的患者的亚组分析显示了相似的结果。
结论：SAC联合围手术期DAPT可能是急性破裂动脉瘤安全有效的治疗策略。此外，它可能对术后脑梗死有保护作用,而不会增加症状性出血性并发症的风险.
