Stent-Supported Aneurysm Coiling: A Literature Survey of Treatment and Follow-Up
Stent-Supported Aneurysm Coiling: A Literature Survey of Treatment and Follow-Up
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DOI：
10.3174/ajnr.a2719
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发表时间：
2012-01-01
影响因子：
3.5
通讯作者：
Nelson, P. K.
中科院分区：
文献类型：
--
作者：
Shapiro, M.;Becske, T.;Nelson, P. K.
背景和目的：在过去几年中，支架支持动脉瘤弹簧圈栓塞术的使用频率越来越高，特别是用于治疗复杂和宽颈动脉瘤。目前已有大量文献描述了支架支持弹簧圈栓塞术的各种经验。本研究的目的是对支架辅助动脉瘤弹簧圈栓塞术进行全面的文献调查。材料和方法：对截至2011年1月报告支架辅助动脉瘤弹簧圈栓塞术结果的论文进行调查，以确定支架相关和其他并发症的患病率、闭塞率以及临床和血管造影随访数据。结果：39篇文章（1517例患者）符合初始分析、随访分析或两者的纳入标准。总体而言，9%的病例受到支架相关技术问题的混淆，包括4%的展开失败。总体手术并发症发生率为19%，围手术期死亡率为2.1%。大约45%的动脉瘤在第一次治疗时完全闭塞，随访时增加到61%。在血管造影随访时观察到约3.5%的支架内狭窄和0.6%的支架闭塞。3%的受试者报告了迟发性卒中或短暂性脑缺血发作。在一个文献子集中，前10例患者的支架相关问题发生率显著高于后续受试者，支持手术“学习曲线”的概念。结论：在有经验的医生中，支架支持弹簧圈栓塞术的发病率比传统的弹簧圈栓塞术略高。正如所料，随着经验的积累，程序的执行似乎有所改进。完全闭塞率仍然较低。需要更多和更长期的血管造影随访信息，以了解延迟支架相关问题，并更好地确定治疗的持久性。
BACKGROUND AND PURPOSE: Stent-supported aneurysm coiling has been utilized with increasing frequency over the past few years, particularly for addressing treatment of complex and wide-neck aneurysms. A sizable body of literature describing various experiences with stent-supported coiling now exists. The purpose of this research was to carry out a comprehensive literature survey of stent-supported aneurysm coiling.MATERIALS AND METHODS: A survey of papers reporting results with stent-assisted aneurysm coiling through January 2011 was conducted to identify the prevalence of stent-related and other complications, occlusion rates, and clinical and angiographic follow-up data.RESULTS: Thirty-nine articles with 1517 patients met inclusion criteria for initial analysis, follow-up analysis, or both. Overall, 9% of cases were confounded by a technical stent-related issue, including 4% failure of deployment. The overall procedure complication rate was 19%, with periprocedural mortality of 2.1%. Approximately 45% of aneurysms were completely occluded at first treatment session, increasing to 61% on follow-up. Approximately 3.5% in-stent stenosis and 0.6% stent occlusion were observed at angiographic follow-up. Delayed stroke or transient ischemic attack was reported in 3% of subjects. Within a subset of articles, the incidence of stent-related issues in the first 10 patients was significantly higher than in subsequent subjects, supporting the notion of a procedural "learning curve."CONCLUSIONS: In experienced hands, the morbidity of stent-supported coiling is somewhat higher compared with "traditional" coiling. As might be expected, execution of the procedure appears improved with experience. Complete occlusion rates remain somewhat low. More and longer term angiographic follow-up information is needed to understand delayed stent-related issues and to better define the durability of treatment.