Current status of endovascular treatment for vasospasm following subarachnoid hemorrhage: analysis of JR-NET2.
Current status of endovascular treatment for vasospasm following subarachnoid hemorrhage: analysis of JR-NET2.
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DOI：
10.2176/nmc.st2013-0149
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发表时间：
2014
影响因子：
1.9
通讯作者：
JR-NET2 Study Group
中科院分区：
文献类型：
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作者：
Hayashi K;Hirao T;Sakai N;Nagata I;JR-NET2 Study Group
血管内治疗用于治疗蛛网膜下腔出血后的脑血管痉挛，但药物治疗无效。然而，治疗的效果或并发症尚不清楚。在此，我们分析了日本Neuroendovascular Therapy Registry 2 （JRNET2）的数据，揭示了血管内治疗脑血管痉挛的现状。JR-NET2从2007年1月1日到2009年12月31日进行。记录患者的临床状况、影像学检查、治疗方法、治疗结果及30天后的状态。共纳入480例患者645次治疗，平均年龄59.4岁，72.7%为女性。对神经系统改善相关因素及治疗相关并发症进行统计学分析。脑动脉瘤破裂直接手术治疗366例，血管内治疗253例。脑血管痉挛的血管内治疗时间在3小时内209例，3 ~ 6小时158例，6小时以上158例。采用动脉内血管扩张剂治疗495例，经皮腔内血管成形术治疗140例。神经学改善372例，影像学改善623例。发生治疗相关并发症20例（3.1%），其中颅内出血6例，脑缺血5例，穿刺部位病变1例，其他8例。统计分析显示，早期治疗与神经系统改善有关。综述了脑血管痉挛血管内治疗的现状。血管内治疗对血管痉挛尤其早期治疗有效。
Endovascular treatments are employed for cerebral vasospasm following subarachnoid hemorrhage, which is not responded to the medical treatments. However, the effect or complication of the treatments is not known well. Here, we analyzed the data of Japanese Registry of Neuroendovascular Therapy 2 (JRNET2) and revealed current status of the endovascular treatment for the cerebral vasospasm. JR-NET2 is conducted from January 1, 2007 to December 31, 2009. Information on the clinical status, imaging studies, treatment methods, the results of treatment, and status 30 days later were recorded. Totally 645 treatments for 480 patients (mean age, 59.4 years; 72.7% woman) were included. Factors related to the neurological improvement and treatment related complications were statistically analyzed. Treatments for ruptured cerebral aneurysm were direct surgery for 366 cases and endovascular treatment for 253 cases. The timing of the endovascular treatment for the cerebral vasospasm was within 3 hours in 209 cases, 3–6 hours in 158 cases, and more than 6 hours in 158 cases. Intra-arterial vasodilator was employed for the 495 cases and percutaneous transluminal angioplasty for 140 cases. Neurological improvement was observed in 372 cases and radiological improvement was seen in 623 cases. The treatment related complication occurred in 20 cases (3.1%), including 6 cases of intracranial hemorrhage, 5 cases of cerebral ischemia, a case of puncture site trouble, and 8 cases of others. Statistical analysis showed early treatment was related to the neurological improvement. Current status of endovascular treatment for cerebral vasospasm was revealed. Endovascular treatment was effective for vasospasm especially was performed early.