Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?
Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?
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DOI：
10.1136/neurintsurg-2016-012745
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发表时间：
2017-11-01
影响因子：
4.8
通讯作者：
Akin, Sule
中科院分区：
文献类型：
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作者：
Andic, Cagatay;Aydemir, Fatih;Akin, Sule
背景和目的多发性动脉瘤的发病率较高，但最佳治疗策略尚不清楚。本研究的目的是评估的安全性和有效性的多个动脉瘤的单阶段血管内治疗与各种血管内techniques.Materials和方法的组合53例连续的多个颅内动脉瘤谁接受了单阶段血管内治疗≥ 2个动脉瘤从2011年6月至2016年5月被纳入本研究。回顾性评价了患者和动脉瘤的特征、治疗技术、并发症、临床和血管造影结果。（97.6%）采用以下血管内技术治疗：简单弹簧圈栓塞术19例，球囊辅助弹簧圈栓塞术27例，支架辅助弹簧圈栓塞术33例，血流导向装置43例，囊内血流调节器2例，颈桥装置1例。总死亡率和与单阶段治疗直接相关的死亡率分别为15%（8/53）和3.7%（2/53）。对44例（83%）患者的104个（83.2%）动脉瘤进行了临床和血管造影随访，平均持续时间为16.2个月（范围3-51个月）。根据最后一次血管造影随访，总闭塞率为85个（81.7%），8个（7.6%）接近完全，11个（10.5%）不完全的动脉瘤。结论单阶段血管内治疗多个动脉瘤的联合血管内技术是可行的，并增加了所有检测到的动脉瘤的治疗可能性。然而，由于相对较高的并发症发生率，该手术的安全性存在争议。特别是，在双侧颈内动脉动脉瘤患者中，可以使用分期治疗代替血流导向装置的同时治疗，以避免血栓栓塞事件。
Background and purpose Multiple aneurysms have a high reported incidence, but the optimal treatment strategy is not clear. The aim of this study was to evaluate the safety and effectiveness of single-stage endovascular treatment of multiple aneurysms with a combination of various endovascular techniques.Materials and methods Fifty-three consecutive patients with multiple intracranial aneurysms who underwent single-stage endovascular treatment for >= 2 aneurysms from June 2011 to May 2016 were included in the study. Patient and aneurysm characteristics, treatment technique, complications, clinical and angiographic outcomes were retrospectively evaluated.Results 125 of 128 aneurysms (97.6%) were treated by the following endovascular techniques: simple coiling in 19, balloon-assisted coiling in 27, stent-assisted coiling in 33, flow diverters in 43, intrasaccular flow modifiers in 2, and a neck-bridging device in 1. Overall mortality and mortality directly related to the single-stage treatment was 15% (8/53) and 3.7% (2/53), respectively. Clinical and angiographic follow-up was available in 44 (83%) patients for 104 (83.2%) aneurysms for a mean duration of 16.2 months (range 3-51 months). According to the last angiographic follow-up, overall occlusion rates were complete in 85 (81.7%), near complete in 8 (7.6%), and incomplete in 11 (10.5%) aneurysms.Conclusions Single-stage endovascular treatment of multiple aneurysms with combined endovascular techniques is technically feasible and increases the treatment possibility of all detected aneurysms. However, the safety of the procedure is controversial due to relatively high complication rates. In particular, in patients with bilateral internal carotid artery aneurysms, staged therapy may be used instead of simultaneous treatment with flow diverters to avoid thromboembolic events.