背景:第一代分流器(FD)的比较功效和安全性,管道栓塞装置(PED)(Medtronic,Irvine,California),真丝(Balt挤压,蒙莫朗西,法国),流重定向腔内装置(FRED)(显微术,Tustin,California),和SurpassStreamline(Stryker神经血管,弗里蒙特,California),没有直接建立,也没有很大程度上推断出来。
目的:本研究旨在比较不同FD治疗侧壁ICA颅内动脉瘤的疗效。
方法:我们从2009-2016年对18个学术机构的前瞻性维护数据库进行了回顾性回顾,包括444例患者,这些患者接受了4种治疗侧壁ICA动脉瘤的装置之一。人口统计数据,动脉瘤特征,治疗结果,并对并发症进行分析。使用各种成像方式和改良的Rankin量表(mRS)评估血管造影和临床结果。采用倾向得分加权来平衡混杂变量。数据分析采用Kaplan-Meier曲线,逻辑回归,和Cox比例风险回归。
结果:虽然再治疗率没有显著差异,功能结果(MRS0-1),四个装置之间的血栓栓塞并发症,Surpass装置在最后一次随访时达到充分闭塞的概率最高(HR:4.59;CI:2.75-7.66,p<0.001),其次是FRED(HR:2.23;CI:1.44-3.46,p<0.001),PED(HR:1.72;CI:1.10-2.70,p=0.018),和丝绸(HR:1.0参考。标准)。唯一的出血并发症是Surpass(1%)。
结论:所有第一代装置在治疗ICA侧壁动脉瘤方面取得了良好的临床效果和再治疗率。从长远来看,需要前瞻性研究来探索这些设备之间的细微差别。
BACKGROUND: The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred.
OBJECTIVE: This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms.
METHODS: We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009-2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression.
RESULTS: While there were no significant differences in retreatment rates, functional outcomes (mRS 0-1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75-7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44-3.46, p < 0.001), PED (HR: 1.72; CI: 1.10-2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%).
CONCLUSIONS: All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term.