Abstract：
OBJECTIVE: Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the aneurysm before clipping decreases IOR.
METHODS: We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination.
RESULTS: We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0 mm [interquartile range 5.95-8.7] vs. 4.6 mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients.
CONCLUSIONS: Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.
METHODS: We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination.
RESULTS: We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0 mm [interquartile range 5.95-8.7] vs. 4.6 mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients.
CONCLUSIONS: Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.
摘要：
目的：术中破裂（IOR）是颅内动脉瘤破裂的手术夹闭过程中最常见的不良事件。除了增加外科医生的经验和早期的近端控制，没有降低IOR风险的方法。因此，我们的目的是评估在夹闭前部分血管内弹簧圈栓塞保护动脉瘤是否降低了IOR.
方法：我们对在两个三级学术中心接受手术夹闭治疗的颅内动脉瘤破裂患者进行了回顾性分析。我们比较了接受部分血管内弹簧圈栓塞术以在夹闭之前保护动脉瘤的患者的患者特征和结果。主要结果是IOR。次要结果是住院死亡率和出院目的地。
结果：我们分析了100例患者。27例患者进行了部分血管内动脉瘤保护。年龄,性别,蛛网膜下腔出血的严重程度，部分栓塞组和非栓塞组之间的动脉瘤位置相似.部分栓塞动脉瘤的中位尺寸较大（7.0mm[四分位距5.95-8.7]vs.4.6mm[3.3-6.0];P<0.001)。在手术夹钳期间，与未栓塞的动脉瘤相比，部分栓塞的动脉瘤发生IOR的频率较低（2/27，7.4％，vs.30/73，41%；P=0.001）。部分栓塞动脉瘤患者的住院死亡率为14.8％（4/27），未栓塞患者的住院死亡率为28.8％（21/73）（P=0.20）。部分栓塞动脉瘤患者出院回家或住院康复率为74.0%，未栓塞患者为56.2%(P=0.11)。2/27（7.4％）患者发生部分栓塞并发症。
结论：术前部分血管内弹簧圈栓塞治疗破裂动脉瘤与手术夹闭治疗期间IOR频率降低有关。这些结果以及术前部分血管内弹簧圈栓塞对功能结局的影响应通过随机试验得到证实。
方法：我们对在两个三级学术中心接受手术夹闭治疗的颅内动脉瘤破裂患者进行了回顾性分析。我们比较了接受部分血管内弹簧圈栓塞术以在夹闭之前保护动脉瘤的患者的患者特征和结果。主要结果是IOR。次要结果是住院死亡率和出院目的地。
结果：我们分析了100例患者。27例患者进行了部分血管内动脉瘤保护。年龄,性别,蛛网膜下腔出血的严重程度，部分栓塞组和非栓塞组之间的动脉瘤位置相似.部分栓塞动脉瘤的中位尺寸较大（7.0mm[四分位距5.95-8.7]vs.4.6mm[3.3-6.0];P<0.001)。在手术夹钳期间，与未栓塞的动脉瘤相比，部分栓塞的动脉瘤发生IOR的频率较低（2/27，7.4％，vs.30/73，41%；P=0.001）。部分栓塞动脉瘤患者的住院死亡率为14.8％（4/27），未栓塞患者的住院死亡率为28.8％（21/73）（P=0.20）。部分栓塞动脉瘤患者出院回家或住院康复率为74.0%，未栓塞患者为56.2%(P=0.11)。2/27（7.4％）患者发生部分栓塞并发症。
结论：术前部分血管内弹簧圈栓塞治疗破裂动脉瘤与手术夹闭治疗期间IOR频率降低有关。这些结果以及术前部分血管内弹簧圈栓塞对功能结局的影响应通过随机试验得到证实。
