Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes
Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes
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DOI：
10.3174/ajnr.a3755
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发表时间：
2014-04-01
影响因子：
3.5
通讯作者：
McDougall, C.
中科院分区：
文献类型：
--
作者：
Hetts, S. W.;Turk, A.;McDougall, C.
背景和目的：支架辅助弹簧圈栓塞可能会减少动脉瘤的再通，但比单独弹簧圈弹簧栓塞产生更多的并发症。我们在多中心 Matrix 和 Platinum 科学试验中评估了带支架和不带支架的弹簧圈的结果。 材料和方法：Matrix 和 Platinum 科学试验中所有患有未破裂颅内动脉瘤且按照方案接受治疗的患者均被纳入。对患者和动脉瘤的基线特征、手术细节、神经系统结果、血管造影结果和安全性数据进行了分析。 结果：总体而言，361 名患者中有 137 名 (38%) 接受了支架治疗。支架螺旋动脉瘤具有更宽的颈部（62% 使用支架的患者≥ 4 mm，而未使用支架的患者为 33%，P < .0001）和较低的穹顶与颈比（1.3 与 1.8，P < .0001）。在接受或不接受支架治疗的患者中，围手术期严重不良事件很少发生（6.6% vs 4.5%，P = .39）。 1 年时，治疗组中总体显着不良事件、死亡率和 mRS 恶化相似，但缺血性卒中在螺旋支架患者中比螺旋支架患者更常见（8.8% 对比 2.2%，P = 0.005）。然而，多变量分析证实，治疗后 2 年，既往脑血管意外 (OR, 4.7; P = .0089) 和动脉瘤颈宽度 >= 4 mm (OR, 4.5; P = .02) 是缺血性中风的唯一独立预测因素。支架的使用并不是 2 年时缺血性卒中的独立预测因素（OR，1.1；P = .94）。支架的使用并不能预测 2 年时目标动脉瘤的复发，但动脉瘤圆顶尺寸 >= 10 mm（OR，9.94；P < .0001）确实可以预测目标动脉瘤的复发。结论：尽管支架动脉瘤的形态比盘绕动脉瘤更困难，但支架弹簧圈与弹簧圈的结果相似。螺旋支架动脉瘤中缺血事件的增加可归因于基线危险因素和动脉瘤形态。这些作者分析了 6 年期间治疗的 131 个未选择的 MCA 动脉瘤的数据。治疗后 1 个月，永久发病率和死亡率为 3.3%，根据所使用的技术没有显着差异。再通率接近16%，且根据技术的不同没有差异，7.6%的病例需要再次治疗。球囊重塑的并发症发生率较高，并且只有较大的动脉瘤才能预测再通。作者得出的结论是，MCA 动脉瘤的血管内治疗是安全、有效且持久的。
BACKGROUND AND PURPOSE:Stent-assisted coiling may result in less aneurysm recanalization but more complications than coiling alone. We evaluated outcomes of coiling with and without stents in the multicenter Matrix and Platinum Science Trial.MATERIALS AND METHODS:All patients in the Matrix and Platinum Science Trial with unruptured intracranial aneurysms treated per protocol were included. Baseline patient and aneurysm characteristics, procedural details, neurologic outcomes, angiographic outcomes, and safety data were analyzed.RESULTS:Overall, 137 of 361 (38%) patients were treated with a stent. Stent-coiled aneurysms had wider necks (>= 4 mm in 62% with stents versus 33% without, P < .0001) and lower dome-to-neck ratios (1.3 versus 1.8, P < .0001). Periprocedural serious adverse events occurred infrequently in those treated with and without stents (6.6% versus 4.5%, P = .39). At 1 year, total significant adverse events, mortality, and worsening of mRS were similar in treatment groups, but ischemic strokes were more common in stent-coiled patients than in coiled patients (8.8% versus 2.2%, P = .005). However, multivariate analysis confirmed that at 2 years after treatment, prior cerebrovascular accident (OR, 4.7; P = .0089) and aneurysm neck width >= 4 mm (OR, 4.5; P = .02) were the only independent predictors of ischemic stroke. Stent use was not an independent predictor of ischemic stroke at 2 years (OR, 1.1; P = .94). Stent use did not predict target aneurysm recurrence at 2 years, but aneurysm dome size >= 10 mm (OR, 9.94; P < .0001) did predict target aneurysm recurrence.CONCLUSIONS:Stent-coiling had similar outcomes as coiling despite stented aneurysms having more difficult morphology than coiled aneurysms. Increased ischemic events in stent-coiled aneurysms were attributable to baseline risk factors and aneurysm morphology.These authors analyzed data on 131 non-selected MCA aneurysms treated during a 6-year period. One month after treatment, permanent morbidity and mortality was 3.3% without significant differences according to technique used. The rate of recanalization was nearly 16%, also without differences according to technique, and re-treatment was needed in 7.6% of cases. A greater rate of complications occurred with balloon remodeling and only large aneurysm size predicted recanalization. The authors concluded that endovascular treatment of MCA aneurysms is safe, effective, and durable.