支架辅助弹簧圈栓塞治疗前循环破裂动脉瘤:与非支架辅助弹簧圈栓塞比较

Stent-assisted coil embolization for ruptured anterior circulation intracranial aneurysms:comparison with non-stent-assisted coil embolization

目的比较支架辅助与非支架辅助弹簧圈栓塞治疗前循环破裂动脉瘤的安全性和有效性。方法回顾性纳入2014年1月至2018年9月期间在德州市人民医院接受介入栓塞治疗的前循环破裂动脉瘤患者。比较支架辅助栓塞组与非支架辅助栓塞组围手术期并发症发生率、病死率和术后30 d临床转归。采用多变量logistic回归分析确定转归不良的独立危险因素。结果共纳入115例患者,共115个动脉瘤。支架辅助栓塞组47例,男性16例,年龄(56.81±10.16)岁;非支架辅助栓塞组68例,男性27例,年龄(52.38±9.60)岁。支架辅助栓塞组人口统计学和基线资料与非支架辅助栓塞组差异无统计学意义,出血并发症、缺血并发症及有症状脑血管痉挛发生率亦差异无统计学意义,但支架辅助栓塞组总体并发症发生率(34.04%对17.65%;P=0.044)、转归不良率(27.66%对10.29%;P=0.016)和病死率(14.89%对2.94%;P=0.046)均显著高于非支架辅助栓塞组。多变量logistic回归分析提示,高血压[优势比(odds ratio,OR)6.000,95%可信区间(confidence interval,CI)1.361~27.363;P=0.021]、糖尿病(OR 6.000,95%CI 1.548~23.255;P=0.010)、支架辅助(OR 12.201,95%CI 2.588~102.002;P=0.002)、围手术期出血并发症(OR 40.286,95%CI 4.508~360.032;P=0.001)和缺血并发症(OR 46.000,95%CI 10.716~197.460;P<0.001)是转归不良的独立危险因素。结论前循环破裂动脉瘤支架辅助栓塞治疗的并发症发生率较高,临床转归也较差,应尽量避免使用。

Objective To compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization for the treatment of ruptured anterior circulation aneurysms.Methods From January 2014 to September 2018,patients with ruptured anterior circulation aneurysms treated with interventional embolization in Dezhou People's Hospital were enrolled retrospectively.The incidence of perioperative complications,mortality,and clinical outcome at 30 d after coil embolization were compared between the stent-assisted embolization group and the non-stent-assisted embolization group.Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes.Results A total of 115 aneurysms were included in 115 patients.There were 47 patients in the stent-assisted embolization group(16 males,aged 56.81±10.16 years)and 68 in the non-stent-assisted embolization group(27 males,aged 52.38±9.60 years).There were no significant differences in the demographic and baseline data between the stent-assisted embolization group and the non-stent-assisted embolization group.There were no significant differences in the incidence of bleeding complications,ischemic complications,and symptomatic cerebral vasospasm as well.However,the overall complication rate(34.04%vs.17.65%;P=0.044),poor outcome rate(27.66%vs.10.29%;P=0.016),and mortality(14.89%vs.2.94%;P=0.046)in stent-assisted embolization group were significantly higher than those in the non-stent assisted embolization group.Multivariate logistic regression analysis indicated that hypertension(odds ratio[OR]6.000,95%confidence interval[CI]1.361-27.363;P=0.021),diabetes(OR 6.000,95%CI 1.548-23.255;P=0.010),stent-assist technique(OR 12.201,95%CI 2.588-102.002;P=0.002),perioperative bleeding complications(OR 40.286,95%CI 4.508-360.032;P=0.001),and ischemic complications(OR 46.000,95%CI 10.716-197.460;P<0.001)were the independent risk factors for poor outcomes.Conclusion Stent-assisted coil embolization for ruptured anterior circulation aneurysms has a high incidence of complications and poor clinical outcomes,and should be avoided as much as possible.