背景:宽颈大脑中动脉分叉动脉瘤对血管内治疗提出了具体的挑战。在许多中心,手术夹闭仍然是这些动脉瘤的标准治疗方法。虽然最近的数据表明血管内治疗可能具有可比性,一直缺乏一个前瞻性的数据点。
方法:半影SMART注册表,一个潜在的,多中心,半影线圈治疗动脉瘤的单臂结果登记,被询问血管内治疗的宽颈MCA分叉动脉瘤(圆顶:颈部比<2或颈部>4毫米)。总结了破裂和未破裂动脉瘤的安全性和有效性结果。包括破裂,并发症发生率,和1年闭塞结局。
结果:纳入31个部位的72个动脉瘤。其中,共有15例动脉瘤破裂。21例(29.2%)患者发生严重不良事件,8(11.1%)归因于设备/程序。术后立即,75.0%的病例达到“足够”的RaymondRoyI级(40.3%)或II级(34.7%)闭塞结果。在接受治疗的72名患者中,60例(83.3%)在1年接受了随访血管造影,其中,95.0%的RaymondRoyI级(71.7%)或II级(23.3%)的1年闭塞结局。在最后一次随访时,总共需要或计划再治疗6个动脉瘤(10.0%)。
结论:这项研究代表了迄今为止进行血管内治疗的MCA宽颈分叉动脉瘤的最重要的前瞻性样本。它支持血管内治疗这些动脉瘤的安全性和有效性。
BACKGROUND: Wide-necked middle cerebral artery bifurcation aneurysms pose specific challenges to endovascular management. Surgical clipping remains the standard treatment approach for these aneurysms in many centers. While recent data suggests the endovascular treatment may be comparable, a prospective datapoint has been lacking.
METHODS: The Penumbra SMART registry, a prospective, multi-center, single-arm outcomes registry of Penumbra coil-treated aneurysms, was queried for endovascularly treated MCA bifurcation aneurysms with wide necks (dome:neck ratio <2 or neck >4 mm). Safety and efficacy outcomes were summarized for ruptured and unruptured aneurysms, including rupture, complication rate, and 1-year occlusion outcomes.
RESULTS: Seventy-two aneurysms across 31 sites were enrolled. Of these, a total of 15 presented as ruptured aneurysms. Serious adverse events were reported in 21 (29.2%) of patients, with 8 (11.1%) attributed to the device/procedure. Immediately postoperatively, 75.0% of cases achieved \"adequate\" Raymond Roy Class I (40.3%) or II (34.7%) occlusion outcomes. Of the 72 patients treated, 60 (83.3%) underwent follow-up angiography at 1 year, and among these, 95.0% had 1-year occlusion outcomes of Raymond Roy Class I (71.7%) or II (23.3%). A total of 6 aneurysms (10.0%) were required or were planned for retreatment at the last follow-up.
CONCLUSIONS: This study represents the most significant prospective sample of endovascularly treated wide-neck MCA bifurcation aneurysms conducted to date. It supports the safety and efficacy of endovascular treatment of these aneurysms.