初次血管内治疗后复发性动脉瘤再次介入治疗的倾向评分匹配分析

Propensity Score Matching Analysis for Retreatment of Recurrent Aneurysms After Primary Interventional Therapy

目的通过倾向评分匹配分析腔内置入血流导向装置(PED)和弹簧圈栓塞治疗颅内初次血管内治疗后复发性动脉瘤的效果。方法回顾性分析2019年1月至2021年7月使用PED和弹簧圈栓塞的复发性动脉瘤患者临床资料。使用倾向评分匹配,收集并比较患者初次治疗时的临床和形态学因素以及再次治疗时的血管造影和临床结果。结果共纳入105例患者,其中18例PED,87例弹簧圈栓塞。共有16对匹配,PED组16例,弹簧圈组32例。PED组支架辅助例数与弹簧圈组比较,差异有统计学意义(P<0.05);随访3个月,PED组复发率低于弹簧圈组,手术失败率和载瘤动脉狭窄率高于弹簧圈组(P<0.05)。结论初次血管内治疗后复发性动脉瘤的血管内再治疗是安全有效的。PED能够降低复发性颅内动脉瘤的再通风险,但会增加手术失败和轻度载瘤动脉狭窄的风险。

Objective The effect of pipeline embolization device(PED)and coil embolization in the treatment of recurrent aneurysms after initial intracranial endovascular therapy was analyzed by propensity score matching.Methods The clinical data of patients with recurrent aneurysms treated with PED and coils from January 2019 to July 2021 were analyzed retrospectively.Propensity score matching was used,and clinical and morphological factors at initial treatment and angiographic and clinical outcomes at retreatment were collected and compared.Results A total of 105 patients were included,including 18 with PED and 87 with coil embolism.There were 16 matching pairs,16 in the PED group and 32 in the coil group.Compared with the coil group,the number of stent-assisted cases in the PED group was statistical different(P<0.05).Follow up for 3 months showed that the recurrence rate of PED group was lower than that of the coil group,and the hand failure rate and the stenosis rate of the parent artery were higher than those of the coil group(P<0.05).Conclusion Endovascular retreatment of recurrent aneurysms after initial endovascular therapy is safe and effective.PED can reduce the risk of recanalization in recurrent intracranial aneurysms,but increase the risk of surgical failure and mild parent artery stenosis.