Subarachnoid Hemorrhage Outcomes in an Endovascular Right of First Refusal Neurosurgical Environment.
Subarachnoid Hemorrhage Outcomes in an Endovascular Right of First Refusal Neurosurgical Environment.
复制标题
血管内优先购买权神经外科环境中的蛛网膜下腔出血结果。
DOI：
10.1016/j.wneu.2023.10.091
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发表时间：
2024
影响因子：
2
通讯作者：
Lang,MichaelJ
中科院分区：
文献类型：
--
作者：
Belkhir,JRaouf;Pease,Matthew;McCarthy,DavidJ;Legarretta,Andrew;Mittal,AdityaM;Crago,ElizabethA;Gross,BradleyA;Lang,MichaelJ
背景随机对照试验表明，与显微外科方法相比，血管内技术可改善结局。然而，并非所有患者都适合血管内治疗。本研究的目的是确定是否健康的患者管理的显微手术可以实现功能的结果可比的患者endovascularly.MethodsPatients治疗破裂的蛛网膜下腔出血在2个1级中风中心从2012年1月至2020年12月进行了回顾性分析。所有病例均在血管内优先权神经外科环境中进行评价。我们收集了相关的临床和随访数据，并建立了一个广义线性模型，以确定血管内治疗与显微手术治疗患者之间的差异。考虑到这些差异的倾向评分模型用于预测患者结局。采用改良兰金量表（mRS）对功能结局进行独立评估，改良兰金量表评分<3分者定义为良好功能结局。结果该研究包括588例患者（211例显微手术，377例血管内）;中位年龄为58岁（四分位距：40-86岁）;住院死亡率为13%。年龄、动脉瘤大小和动脉瘤位置显著预测治疗方式（均P < 0.05）。在贪婪型匹配（210例显微手术，210例血管内）后，显微手术治疗的患者出院回家的可能性较小（比值比= 0.6，95%可信区间0.4- 0.9，P = 0.01）。随着时间的推移，功能差异消失; 2个治疗组的患者在3个月时的功能结局相似（比值比= 1.1，95%置信区间0.7- 1.8，P = 0.66）和蛛网膜下腔出血后1年（比值比= 1.3，95%可信区间0.8- 2.1，P = 0.38）。结论在血管内神经外科手术环境中，从业者可以通过显微外科手术治疗不适合血管内治疗的患者，并获得与血管内治疗的患者相当的功能结果。
BackgroundRandomized controlled trials demonstrate that endovascular techniques yield improved outcomes compared with microsurgical approaches. However, not all patients are suitable candidates for endovascular management. This study aimed to determine if healthy patients managed microsurgically could achieve functional outcomes comparable to patients managed endovascularly.MethodsPatients treated for ruptured aneurysmal subarachnoid hemorrhage at 2 level 1 stroke centers from January 2012 through December 2020 were retrospectively reviewed. All cases were evaluated in an endovascular right of first refusal neurosurgical environment. We collected relevant clinical and follow-up data and created a generalized linear model to identify differences between patients treated endovascularly versus microsurgically. A propensity score model accounting for these differences was used to predict patient outcomes. Functional outcomes were independently assessed using the modified Rankin Scale (mRS) with good functional outcome defined as modified Rankin Scale score <3.ResultsThe study included 588 patients (211 microsurgical, 377 endovascular); median age was 58 years (interquartile range: 40–86 years); in-hospital mortality was 13%. Age, aneurysm size, and aneurysm location significantly predicted treatment modality (allP< 0.05). After greedy-type matching (210 microsurgical, 210 endovascular), patients managed microsurgically were less likely to be discharged home (odds ratio = 0.6, 95% confidence interval 0.4–0.9,P= 0.01). Functional differences disappeared over time; patients in the 2 treatment arms had similar functional outcomes at 3 months (odds ratio = 1.1, 95% confidence interval 0.7–1.8,P= 0.66) and 1 year after subarachnoid hemorrhage (odds ratio = 1.3, 95% confidence interval 0.8–2.1,P= 0.38).ConclusionsIn an endovascular right of first refusal neurosurgical environment, practitioners can treat patients who are not good endovascular candidates microsurgically and achieve functional outcomes comparable to patients managed endovascularly.