Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment
Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment
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DOI：
10.1016/s0140-6736(03)13860-3
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发表时间：
2003-07-12
期刊：
影响因子：
168.9
通讯作者：
Marler, JR
中科院分区：
文献类型：
--
作者：
Wiebers, D;Whisnant, JP;Marler, JR
背景未破裂颅内动脉瘤的治疗是有争议的。未破裂颅内动脉瘤的国际研究的目的是评估未破裂颅内动脉瘤的自然史，并测量与其repair.Methods中心在美国，加拿大和欧洲招募患者的未破裂动脉瘤的前瞻性评估的风险。研究者记录了没有接受手术的患者的自然病史，并评估了与开放手术或血管内手术修复未破裂动脉瘤相关的发病率和死亡率。结果4060例患者进行了评估-1692例没有接受动脉瘤修复，1917例接受了开放手术，451例接受了血管内手术。5-无蛛网膜下腔出血病史且动脉瘤位于颈内动脉、前交通动脉或大脑前动脉或大脑中动脉的患者的年累积破裂率分别为0%、2.6%、14.5%和40%，动脉瘤小于7 mm、7-12 mm、13-24 mm和25 mm或更大，而涉及后循环和后交通动脉瘤的相同尺寸类别的发生率分别为2.5%、14.5%、18.4%和50%。这些发生率通常等于或超过与可比病变的手术或腔内修复相关的风险。患者的年龄是手术结果的一个强有力的预测因素，动脉瘤的大小和位置可以预测手术和血管内治疗的结果。未破裂颅内动脉瘤患者的治疗涉及许多因素。应将自然史的部位、尺寸和组特异性风险与每个患者的部位、尺寸和年龄特异性修复风险进行比较。
Background The management of unruptured intracranial aneurysms is controversial. Investigators from the International Study of Unruptured Intracranial Aneurysms aimed to assess the natural history of unruptured intracranial aneurysms and to measure the risk associated with their repair.Methods Centres in the USA, Canada, and Europe enrolled patients for prospective assessment of unruptured aneurysms. Investigators recorded the natural history in patients who did not have surgery, and assessed morbidity and mortality associated with repair of unruptured aneurysms by either open surgery or endovascular procedures.Findings 4060 patients were assessed-1692 did not have aneurysmal repair, 1917 had open surgery, and 451 had endovascular procedures. 5-year cumulative rupture rates for patients who did not have a history of subarachnoid haemorrhage with aneurysms located in internal carotid artery, anterior communicating or anterior cerebral artery, or middle cerebral artery were 0%, 2.6%, 14.5%, and 40% for aneurysms less than 7 mm, 7-12 mm, 13-24 mm, and 25 mm or greater, respectively, compared with rates of 2.5%, 14.5%, 18.4%, and 50%, respectively, for the same size categories involving posterior circulation and posterior communicating artery aneurysms. These rates were often equalled or exceeded by the risks associated with surgical or endovascular repair of comparable lesions. Patients' age was a strong predictor of surgical outcome, and the size and location of an aneurysm predict both surgical and endovascular outcomes.Interpretation. Many factors are involved in management of patients with unruptured intracranial aneurysms. Site, size, and group specific risks of the natural history should be compared with site, size, and age-specific risks of repair for each patient.