Cerebral Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Comparison of Management Approaches.
Cerebral Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Comparison of Management Approaches.
复制标题
常染色体显性多囊肾病的脑动脉瘤：治疗方法的比较。
DOI：
10.1093/neuros/nyy336
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发表时间：
2019
期刊：
影响因子：
4.8
通讯作者：
Pandey,AdityaS
中科院分区：
文献类型：
--
作者：
Wilkinson,DAndrew;Heung,Michael;Deol,Amrit;Chaudhary,Neeraj;Gemmete,JosephJ;Thompson,BGregory;Pandey,AdityaS
背景常染色体显性多囊肾病（ADPKD）是颅内动脉瘤（IAs）形成的危险因素，尽管该人群的理想筛查和治疗策略尚不清楚。目的报告ADPKD患者破裂和未破裂动脉瘤的观察、开放手术或血管内治疗的结果。方法回顾性分析2000年至2016年同一中心的所有ADPKD和IAs患者。结果45例ADPKD患者共发现71个动脉瘤，其中蛛网膜下腔出血（SAH） 11例。22例经观察处理的动脉瘤，在136年的临床随访中无一例破裂。35例动脉瘤采用开腹手术，14例采用血管内入路。在接受治疗的动脉瘤中，只有出现SAH的患者出现了较差的神经系统预后（改良Rankin评分>2）(17% SAH vs 0%选择性，P=。06)。急性肾损伤（AKI）也与SAH表现显著相关(22% SAH vs 0%选择性，P=。05）. 手术并发症和AKI均与治疗方式无关。在已知IAs患者175年的影像学随访中，发现8个新生动脉瘤，其中3个得到治疗。在11例SAH患者中，7例在先前已知的ADPKD背景下破裂，其中2例事先进行了血管造影筛查，5例未进行筛查。结论：不良的预后只发生在出现破裂的情况下，但在不同的治疗方式之间是相同的。筛查只是选择性地进行的，64%（11人中有7人）的SAH患者以前已知ADPKD。
BACKGROUNDAutosomal dominant polycystic kidney disease (ADPKD) is a risk factor for formation of intracranial aneurysms (IAs), though the ideal screening and treatment strategies in this population are unclear.OBJECTIVETo report outcomes of observation, open surgical, or endovascular management of ruptured and unruptured aneurysms in patients with ADPKD.METHODSWe performed a retrospective analysis of all patients with ADPKD and IAs at a single center from 2000 to 2016.RESULTSForty-five patients with ADPKD harboring 71 aneurysms were identified, including 11 patients with subarachnoid hemorrhage (SAH). Of 22 aneurysms managed with observation, none ruptured in 136 yr of clinical follow-up. Thirty-five aneurysms were treated with open surgery and 14 with an endovascular approach. Among treated aneurysms, poor neurologic outcome (modified Rankin scale> 2) was seen only in patients presenting with SAH (17% SAH vs 0% elective, P=. 06). Acute kidney injury (AKI) was also significantly associated with SAH presentation (22% SAH vs 0% elective, P=. 05). Neither procedural complications nor AKI were associated with treatment modality. Among 175 yr of radiographic follow-up in patients with known IAs, 8 de novo aneurysms were found, including 3 that were treated. Of 11 patients with SAH, 7 ruptured in the setting of previously known ADPKD, including 2 with prior angiographic screening and 5 without screening.CONCLUSIONPoor outcomes occurred only with ruptured presentation but were equivalent between treatment modalities. Screening is performed only selectively, and 64%(7 of 11) of patients presenting with SAH had previously known ADPKD.