Predictors of Favorable Outcome of Intracranial Basilar Dissecting Aneurysm
Predictors of Favorable Outcome of Intracranial Basilar Dissecting Aneurysm
复制标题
颅内基底动脉夹层动脉瘤良好结果的预测因素
DOI：
10.1016/j.jstrokecerebrovasdis.2015.05.013
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发表时间：
2015-08-01
影响因子：
2.5
通讯作者：
Duan, Chuan-Zhi
中科院分区：
文献类型：
--
作者：
Li, Hui;Zhang, Xin;Duan, Chuan-Zhi
背景：颅内基底动脉夹层动脉瘤的治疗一直存在争议和挑战，手术和保守治疗通常预后不佳。我们的研究旨在评估血管内治疗这些病变的结果，并探索良好结果的预测因素。方法：回顾分析2006年1月至2013年1月收治的50例基底动脉夹层动脉瘤患者的临床资料。24例患者接受了支架辅助卷绕，26例患者接受了保守治疗。采用改良Rankin量表(MRS)评分评价随访结果。结果：支架置入组20例预后良好(MRS评分0~1分)，3例术后复发，1例再出血，2例无再出血。接受保守治疗(观察或抗凝)的患者中，10例预后不良，2例动脉瘤破裂后再出血，8例因梗塞进展而预后不良。支架辅助组的预后优于保守治疗组(83.3%对55.2%，P=.019)。血管内治疗组早期完全闭塞与良好预后相关(P=0.042)。在Logistic回归分析中，支架放置是唯一一个独立预测有利结果的因素(P=.030；优势比=5.828；95%可信区间1.192-28.503)。结论：支架辅助弹簧圈治疗基底动脉夹层动脉瘤的疗效优于保守治疗。支架置入和首次完全闭塞是治疗基底动脉夹层动脉瘤的有利因素。
Background: Management of intracranial basilar dissecting aneurysms has been controversial and challenging, and surgical and conservative treatments usually have a bad prognosis. Our study aimed at evaluating the outcomes of endovascular treatment for these lesions and exploring the predictors of favorable outcome. Methods: We retrospectively reviewed 50 consecutive patients with basilar dissecting aneurysms from January 2006 to January 2013. Twenty-four patients underwent stent-assisted coiling whereas 26 patients underwent conservative treatment. Follow-up outcomes were evaluated using modified Rankin Scale (mRS) score. Results: Of the patients treated with stent-assisted coiling, 20 patients had a favorable outcome (mRS score, 0-1), post-treatment recurrence occurred in 3 patients, 1 had rebleeding, and 2 had no rebleeding. Of the patients treated with conservative therapy (observation or anticoagulation), 10 patients had an unfavorable outcome, 2 patients with ruptured aneurysms developed rebleeding, and 8 patients had poor outcome because of infarct progression. Stent-assisted coiling group had a more favorable outcome than the conservatively treated group (83.3% versus 55.2%, P = .019). Initial complete obliteration was related to the favorable outcome in endovascular-treated group (P = .042). Stent placement was the only independent predictor of favorable outcome in the logistic regression analysis (P = .030; odds ratio = 5.828; 95% confidence interval, 1.192-28.503). Conclusions: Patients with basilar artery dissecting aneurysms treated with stent-assisted coiling had a more favorable outcome than the conservatively treated patients. Stent placement and initial complete occlusion were the favorable factors in patients with basilar dissecting aneurysm.