目的:在急性蛛网膜下腔出血病例中使用支架辅助卷绕(SAC)与较高的出血和缺血性并发症发生率相关。这项研究的目的是评估SAC技术在治疗破裂的颅内动脉瘤(RIA)中的安全性和有效性。
方法:对接受SAC或单用线圈(CA)治疗的RIA患者进行回顾性分析。单因素分析比较两组临床资料。采用倾向评分匹配法选择患者进行比较,分析手术并发症,预后,两组的影像学结果。
结果:共纳入394个动脉瘤,应用倾向评分匹配后,仍有272个动脉瘤,在SAC和CA组中,136例病例的分布相等。两组术后即刻结果无统计学差异(63.2%的SAC患者在Raymond-Roy闭塞分类量表上达到1级,而58.8%的CA患者,差异[95%CI]4.4%[-0.076至0.163];33.1%达到2级比38.2%,5.1%[-0.065至0.170];3.7%实现三级,2.9%,0.8%[-0.047至0.062],p=0.506)。在1年的随访中,SAC组表现出更高的完全闭塞率(59.5%vs42.4%,17.1%[0.040-0.294])和稳定性(24.0%对19.2%,4.8%[-0.061至0.156]),虽然改善率较低(12.4%对22.4%,10.0%[0.001-0.201])和再通(4.1%vs16.0%,11.9%[0.036-0.120]),这些结果具有统计学上的显著差异(p<0.001)。在出院时改良Rankin量表(mRS)评分方面,临床结局没有显着差异(mRS评分为0-2,0.7%[-0.098至0.113]的76.5%vs77.2%;mRS评分为3-6,0.7%[-0.098至0.113]的22.8%vs22.8%,p=0.886)和1年随访(90.8%vs92.2%的mRS评分为0-2,1.4%[-0.063至0.091];9.2%vs7.8%的mRS评分为3-6,1.4%[-0.063至0.091],p=0.683)。与CA组相比,SAC组发生术中破裂的频率更高,尽管差异无统计学意义(5.1%vs2.9%,2.2%[-0.035至0.081],p=0.356)。SAC组显示出术中血栓形成的发生率较高,但差异无统计学意义(8.1%vs2.9%,5.2%[-0.010至0.117],p=0.063)。SAC组术后血栓升高3倍,但这一差异没有统计学意义(6.6%vs2.2%,4.4%[-0.013,0.106],p=0.076)。手术相关的死亡率在两组之间没有显着差异(4.4%vs5.9%,1.5%[-0.048至0.077],p=0.583)。
结论:尽管RIA的支架治疗会导致一些并发症,它是安全和有效的。此外,SAC组血管成像结果优于CA组.
OBJECTIVE: The use of stent-assisted coiling (SAC) in acute subarachnoid hemorrhage cases is associated with higher incidence rates of bleeding and ischemic complications. The aim of this study was to evaluate the safety and efficacy of the SAC technique in the treatment of ruptured intracranial aneurysms (RIAs).
METHODS: A retrospective analysis was conducted on patients with RIAs treated with SAC or coiling alone (CA). Univariate analysis compared clinical information between the two groups. Propensity score matching was used to select patients for comparison and analyze surgical complications, prognosis, and imaging outcomes in both groups.
RESULTS: A total of 394 aneurysms were included, and 272 aneurysms remained after application of propensity score matching, with an equal distribution of 136 cases in both the SAC and CA groups. There was no statistically significant difference in the immediate postoperative outcomes between the two groups (63.2% of SAC patients achieved class 1 on the Raymond-Roy occlusion classification scale vs 58.8% of CA patients, difference [95% CI] 4.4% [-0.076 to 0.163]; 33.1% achieved class 2 vs 38.2%, 5.1% [-0.065 to 0.170]; 3.7% achieved class 3 vs 2.9%, 0.8% [-0.047 to 0.062], p = 0.506). At the 1-year follow-up, the SAC group exhibited higher rates of complete occlusion (59.5% vs 42.4%, 17.1% [0.040-0.294]) and stability (24.0% vs 19.2%, 4.8% [-0.061 to 0.156]), while experiencing lower rates of improvement (12.4% vs 22.4%, 10.0% [0.001-0.201]) and recanalization (4.1% vs 16.0%, 11.9% [0.036-0.120]), with statistically significant differences in these outcomes (p < 0.001). No significant disparities were observed in clinical outcomes in terms of modified Rankin Scale (mRS) scores at discharge (76.5% vs 77.2% had mRS score 0-2, 0.7% [-0.098 to 0.113]; 23.5% vs 22.8% had mRS score 3-6, 0.7% [-0.098 to 0.113], p = 0.886) and 1-year follow-up (90.8% vs 92.2% had mRS score 0-2, 1.4% [-0.063 to 0.091]; 9.2% vs 7.8% had mRS score 3-6, 1.4% [-0.063 to 0.091], p = 0.683). Intraoperative rupture occurred more frequently in the SAC group compared with the CA group, although the difference was not statistically significant (5.1% vs 2.9%, 2.2% [-0.035 to 0.081], p = 0.356). The SAC group demonstrated a higher incidence of intraoperative thrombosis, but the difference was not statistically significant (8.1% vs 2.9%, 5.2% [-0.010 to 0.117], p = 0.063). Postoperative thrombosis in the SAC group was 3 times higher, but this difference was not statistically significant (6.6% vs 2.2%, 4.4% [-0.013, 0.106], p = 0.076). The surgery-related mortality rates did not differ significantly between the two groups (4.4% vs 5.9%, 1.5% [-0.048 to 0.077], p = 0.583).
CONCLUSIONS: Although stent treatment for RIA results in some incidents of complications, it is safe and effective. Besides, the SAC group showed better vascular imaging results compared with the CA group.