Unruptured intracranial aneurysms -: Risk of rupture and risks of surgical intervention
Unruptured intracranial aneurysms -: Risk of rupture and risks of surgical intervention
复制标题
DOI：
10.1056/nejm199812103392401
复制
发表时间：
1998-12-10
影响因子：
158.5
通讯作者：
Kivisaari, R
中科院分区：
文献类型：
--
作者：
Wiebers, D;Whisnant, J;Kivisaari, R
背景：未破裂的颅内动脉瘤的治疗需要了解这些病变的自然病史和修复的风险。方法本研究共纳入美国、加拿大和欧洲53个参与中心的2621名患者，包括回顾和前瞻性研究。在回顾部分中，我们评估了1449例1937个未破裂的颅内动脉瘤的自然病史，其中727例患者没有来自不同动脉瘤的蛛网膜下腔出血史(组1)，722例患者有来自不同动脉瘤且已成功修复的蛛网膜下腔出血史(组2)。在前瞻性部分，我们评估了1172例新诊断的未破裂的颅内动脉瘤患者与治疗相关的发病率和死亡率。结果在第一组中，直径小于10 mm的动脉瘤的年累积破裂率低于0.05%，而在第二组中，其累积破裂率约为其11倍(0.5%/年)。两组直径均大于或等于10 mm的动脉瘤的年破裂率均小于1%，但第一组中直径大于或等于25 mm的巨大动脉瘤的年破裂率为6%。动脉瘤的大小和位置是破裂的独立预测因素。术后30天，第1组和第2组的手术相关发病率和死亡率分别为17.5%和13.6%，1年时分别为15.7%和13.1%。年龄独立预测手术结果。结论1组患者中直径小于10 mm的未破裂颅内动脉瘤破裂的可能性极低，而在2组患者中与手术相关的发病率和死亡率显著高于未破裂的直径小于10 mm的颅内动脉瘤患者7.5年的破裂风险。(N Engl J Med 1998；339：1725-33)(C)1998年，马萨诸塞州医学会。
Background The management of unruptured intracranial aneurysms requires knowledge of the natural history of these lesions and the risks of repairing them.Methods A total of 2621 patients at 53 participating centers in the United States, Canada, and Europe were enrolled in the study, which had retrospective and prospective components. In the retrospective component, we assessed the natural history of unruptured intracranial aneurysms in 1449 patients with 1937 such aneurysms; 727 of the patients had no history of subarachnoid hemorrhage from a different aneurysm (group 1), and 722 had a history of subarachnoid hemorrhage from a different aneurysm that had been repaired successfully (group 2). In the prospective component, we assessed treatment-related morbidity and mortality in 1172 patients with newly diagnosed unruptured intracranial aneurysms.Results In group 1, the cumulative rate of rupture of aneurysms that were less than 10 mm in diameter at diagnosis was less than 0.05 percent per year, and in group 2, the rate was approximately 11 times as high (0.5 percent per year). The rupture rate of aneurysms that were 10 mm or more in diameter was less than 1 percent per year in both groups, but in group 1, the rate was 6 percent the first year for giant aneurysms (greater than or equal to 25 mm in diameter). The size and location of the aneurysm were independent predictors of rupture. The overall rate of surgery-related morbidity and mortality was 17.5 percent in group 1 and 13.6 percent in group 2 at 30 days and was 15.7 percent and 13.1 percent, respectively, at 1 year. Age independently predicted surgical outcome. Conclusions The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter. (N Engl J Med 1998;339:1725-33.) (C) 1998, Massachusetts Medical Society.