Unruptured Giant Intracranial Aneurysms: Risk Factors for Mortality and Long-Term Outcome
Unruptured Giant Intracranial Aneurysms: Risk Factors for Mortality and Long-Term Outcome
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未破裂的巨大颅内动脉瘤：死亡和长期结果的危险因素
DOI：
10.1007/s12975-020-00861-6
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发表时间：
2020-11-09
影响因子：
6.9
通讯作者：
Zhao, Jizong
中科院分区：
文献类型：
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作者：
Lu, Junlin;Li, Mingtao;Zhao, Jizong
本研究旨在探讨不同治疗方式下未破裂颅内巨动脉瘤（GIAs）的远期预后，并分析影响预后的因素。我们对2011年至2018年在我院治疗的未破裂GIAs患者进行了回顾性医疗记录回顾。预后比较最佳药物治疗（保守治疗，CT）和手术（ST）或血管内治疗（ET）。对死亡率的危险因素进行了调查。本研究共纳入276例患者。CT占16.3%，ST占30.1%，ET占53.6%。平均随访7年，CT后破裂率为22.2%，占年破裂率7.3%。ST和ET术后并发症发生率分别为30.1%和8.1%。ET术后复发率为10.1%，ST术后为1.2%。未破裂GIAs的随访死亡率在CT后为26.7%，ST后为7.2%，ET后为5.4%。年龄（50~59岁，HR 5.877； 60~69岁，HR 8.565）、大小≥40 mm （HR 3.916）和后循环位置（HR 6.411）与死亡率增加相关。ET显著降低死亡率（HR 0.191）。由于自然历史上的高破裂率和死亡率，如果可行，未破裂的GIAs需要治疗。高龄、后循环位置、体型较大是预后不良的危险因素。ST和ET的死亡率均低于CT。ST的复发率低于ET， ET的并发症发生率低于ST。
This study aims to investigate the long-term outcomes of unruptured giant intracranial aneurysms (GIAs) with different treatment modalities and to analyze the factors affecting prognosis. We performed a retrospective medical record review of patients with unruptured GIAs treated at our institution from 2011 to 2018. Prognosis was compared to the best medical treatment without intervention (conservative treatment, CT) and surgical (ST) or endovascular (ET) treatment. Risk factors for mortality were investigated. A total of 276 patients were included in this study. Patients received CT in 16.3%, ST in 30.1%, and ET in 53.6% of cases. After an average 7-year follow-up, the rupture rate after CT was 22.2%, accounting for an annual rupture rate of 7.3%. The postoperative complication rate was 30.1% and 8.1% after ST and ET, respectively. The recurrence rate after ET was 10.1%, compared with ST which was 1.2%. The follow-up mortality in unruptured GIAs was 26.7% after CT, 7.2% after ST, and 5.4% after ET. Older age (50~59, HR 5.877; 60~69, HR 8.565), size ≥ 40 mm (HR 3.916), and posterior circulation location (HR 6.411) were associated with increased mortality. ET significantly decreased mortality (HR 0.191). Unruptured GIAs warrant treatment if feasible due to the high rupture rate and mortality of the natural history. Older age, posterior circulation location, and larger size are risk factors for poor prognosis. Both ST and ET showed a lower mortality rate than CT. ST showed less likely recurrence compared to ET, while ET had a lower complication rate than ST.