Occurrence and impact of delayed cerebral ischemia after coiling and after clipping in the International Subarachnoid Aneurysm Trial (ISAT).
Occurrence and impact of delayed cerebral ischemia after coiling and after clipping in the International Subarachnoid Aneurysm Trial (ISAT).
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DOI：
10.1007/s00415-011-6243-2
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发表时间：
2012-04
影响因子：
6
通讯作者：
Molyneux AJ
中科院分区：
文献类型：
--
作者：
Dorhout Mees SM;Kerr RS;Rinkel GJ;Algra A;Molyneux AJ
迟发性脑缺血（DCI）是蛛网膜下腔出血（SAH）后预后不良的重要原因。我们在国际蛛网膜下腔动脉瘤试验中研究了弹簧圈栓塞术后和夹闭术后临床定义的DCI发生率和影响的差异。我们采用逻辑回归分析计算了夹闭术与弹簧圈栓塞术的DCI比值比（OR）。以未发生DCI的弹簧圈栓塞患者作为参照组，我们计算了发生DCI的弹簧圈栓塞患者以及未发生DCI和发生DCI的夹闭患者在2个月和1年时不良结局的OR。根据这些OR，我们计算了相互作用引起的相对超额风险（RERI）。与弹簧圈栓塞术相比，夹闭术增加了2，143例患者的DCI风险，OR 1.24，95%置信区间（95% CI 1.01-1.51）。有DCI的弹簧圈栓塞患者、无DCI的夹闭患者和有DCI的夹闭患者的不良结局风险均高于无DCI的弹簧圈栓塞患者。夹闭和DCI在2个月时未显示不良结局的相互作用：RERI 0.12（95% CI −1.16至1.40）或1年：RERI −0.48（95% CI −1.69至0.74）。仅在4天内接受治疗的患者中，弹簧圈栓塞术和DCI与1年时的结局比夹闭术和DCI差（RERI −2.02，95% CI −3.97至−0.08）。在ISAT的SAH患者中，夹闭后DCI比弹簧圈栓塞后更常见。DCI对不良结局的影响在夹闭和弹簧圈栓塞患者之间没有差异，但在4天内接受治疗的患者除外，其中弹簧圈栓塞后DCI导致不良结局的频率高于夹闭后。
Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). We studied differences in incidence and impact of DCI as defined clinically after coiling and after clipping in the International Subarachnoid Aneurysm Trial. We calculated odds ratios (OR) for DCI for clipping versus coiling with logistic regression analysis. With coiled patients without DCI as the reference group, we calculated ORs for poor outcome at 2 months and 1 year for coiled patients with DCI and for clipped patients without, and with DCI. With these ORs, we calculated relative excess risk due to Interaction (RERI). Clipping increased the risk of DCI compared to coiling in the 2,143 patients OR 1.24, 95% confidence interval (95% CI 1.01–1.51). Coiled patients with DCI, clipped patients without DCI, and clipped patients with DCI all had higher risks of poor outcome than coiled patients without DCI. Clipping and DCI showed no interaction for poor outcome at 2 months: RERI 0.12 (95% CI −1.16 to 1.40) or 1 year: RERI −0.48 (95% CI −1.69 to 0.74). Only for patients treated within 4 days, coiling and DCI was associated with a poorer outcome at 1 year than clipping and DCI (RERI −2.02, 95% CI −3.97 to −0.08). DCI was more common after clipping than after coiling in SAH patients in ISAT. Impact of DCI on poor outcome did not differ between clipped and coiled patients, except for patients treated within 4 days, in whom DCI resulted more often in poor outcome after coiling than after clipping.
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影响因子：
8.3
作者：
VANSWIETEN, JC;KOUDSTAAL, PJ;VANGIJN, J
通讯作者：
VANGIJN, J
影响因子：
48
作者：
Nieuwkamp, Dennis J.;Setz, Larissa E.;Rinkel, Gabriel E.
通讯作者：
Rinkel, Gabriel E.
影响因子：
4.8
作者：
MIZUKAMI, M;KAWASE, T;TAZAWA, T
通讯作者：
TAZAWA, T
影响因子：
8.3
作者：
Koivisto, T;Vanninen, R;Vapalahti, M
通讯作者：
Vapalahti, M
影响因子：
11
作者：
Roos, YBWEM;de Haan, RJ;Vermeulen, M
通讯作者：
Vermeulen, M