Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team
Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team
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DOI：
10.1227/01.neu.0000125325.22576.83
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发表时间：
2004-06-01
期刊：
影响因子：
4.8
通讯作者：
Ogilvy, CS
中科院分区：
文献类型：
--
作者：
Hoh, BL;Cheung, AC;Ogilvy, CS
目的：在许多中心，患者同时接受计算机断层扫描血管造影（CTA）和数字减影血管造影（DSA）。这种做法否定了CTA的大部分优点，并使这两种技术的风险和缺点相加。文献中的先前报告已经评估了CTA与DSA相比的敏感性和特异性;然而，这些研究没有分析用CTA代替DSA作为脑动脉瘤患者唯一诊断和预处理计划研究的方案的临床意义。自2001年底/2002年初以来，马萨诸塞州总医院的联合神经血管科已经采用了CTA替代DSA作为唯一的诊断和预处理脑动脉瘤（破裂和未破裂）患者的计划研究。结果：2002年1月至2003年1月12个月期间，马萨诸塞州总医院神经血管联合小组对223例脑动脉瘤患者进行了初步诊断评估。在223例患者中，109例患者确诊为蛛网膜下腔出血（A组），114例患者未发生SAH（第13组）。所有这些患者均纳入前瞻性CTA方案。A组93例患者（86%）、B组89例患者（78%）和总体182例患者（82%）仅根据CTA开始脑动脉瘤治疗。治疗包括152例患者（68%）的手术夹闭，56例患者（25%）的血管内弹簧圈栓塞，4例患者（2%）的载瘤动脉球囊闭塞，2例患者（1%）的颈外动脉至颈内动脉搭桥术和颈动脉手术闭塞。9例患者（4%）未接受治疗。两组中CTA对存在动脉瘤（A组中的破裂动脉瘤或第13组中的症状性/存在动脉瘤）的脑动脉瘤检出率均为100%。CTA对总脑动脉瘤（包括偶发多发性动脉瘤）的检出率在A组中为95.3%，在第13组中为98.3%，总体为97%。与DSA相关的总体发病率（治疗前或术中或术后金属夹评价）为1例患者（1.3%）有轻微的非神经系统并发症，1例患者（1.3%）有轻微的神经系统并发症，没有患者（0%）有严重的神经系统并发症。我们已经证明了CTA替代DSA作为破裂和未破裂脑动脉瘤患者的唯一诊断和预处理计划研究的前瞻性方案具有良好的结果。在大多数破裂和未破裂的脑动脉瘤患者中，基于CTA而不进行DSA来决定治疗似乎是安全有效的。
OBJECTIVE: At many centers, patients undergo both computed tomographic angiography (CTA) and digital subtraction angiography (DSA). This practice negates most of the advantages of CTA, and it renders the risks and disadvantages of the two techniques additive. Previous reports in the literature have assessed the sensitivity and specificity of CTA compared with DSA; however, these investigations have not analyzed the clinical implications of a protocol that replaces DSA with CTA as the only diagnostic and pretreatment planning study for patients with cerebral aneurysms.METHODS: Since late 2001/early 2002, the combined neurovascular unit of the Massachusetts General Hospital has adopted a prospective protocol of CTA in place of DSA as the only diagnostic and pretreatment planning study for patients with cerebral aneurysms (ruptured and unruptured). We report the results obtained during the 12-month period from January 2002 to January 2003.RESULTS: During the study period, 223 patients with cerebral aneurysms underwent initial diagnostic evaluation for cerebral aneurysm by the combined neurovascular team of Massachusetts General Hospital. Of the 223 patients, 109 patients had confirmed subarachnoid hemorrhage (Group A) and 114 patients did not have SAH (Group 13). All of these patients were included in the prospective CTA protocol. Cerebral aneurysm treatment was initiated on the basis of CTA alone in 93 Group A patients (86%), in 89 Group B patients (78%), and in 182 patients (82%) overall. Treatment consisted of surgical clipping in 152 patients (68%), endovascular coiling in 56 patients (25%), enclovascular parent artery balloon occlusion in 4 patients (2%), and external carotid artery to internal carotid artery bypass and carotid artery surgical occlusion in 2 patients (1%). Nine patients (4%) did not undergo treatment. The cerebral aneurysm detection rate by CTA was 100% for the presenting aneurysm (ruptured aneurysm in Group A or symptomatic/presenting aneurysm in Group 13) in both groups. The detection rate by CTA for total cerebral aneurysms, including incidental multiple aneurysms, was 95.3% in Group A, 98.3% in Group 13, and 97% overall. The overall morbidity associated with DSA (pretreatment or as intraoperative or postoperative clip evaluation) was one patient (1.3%) with a minor nonneurological complication, one patient (1.3%) with a minor neurological complication, and no patients (0%) with a major neurological complication.CONCLUSION: We have demonstrated promising results with a prospective protocol of CTA in place of DSA as the only diagnostic and pretreatment planning study for patients with ruptured and unruptured cerebral aneurysms. It seems safe and effective to make decisions regarding treatment on the basis of CTA, without performing DSA, in the majority of patients with ruptured and unruptured cerebral aneurysms.