文献回顾未破裂动脉瘤.ppt

Reviewofpublishedpapers,HuPeng2010-7-20,Pierot,L.,L.Spelle,andF.Vitry,Immediateclinicaloutcomeofpatientsharboringunrupturedintracranialaneurysmstreatedbyendovascularapproach:resultsoftheATENAstudy.Stroke,2008.39(9):p.2497-504.,ATENA:AnalysisofTreatmentbyEndovascularapproachofNonrupturedAneurysms.ConductedbytheFrenchSocietyofNeuroradiology(SFNR)27CanadianandFrenchneurointerventionalcenters.17months,Patientsandaneurysmcriterea,aneurysmslessthan15mm.Excludedaneurysms:FusiformanddissectinganeurysmsaneurysmsassociatedwithbrainarteriovenousmalformationsIncaseofrecentsubarachnoidhemorrhage(1month)relatedtoanotheraneurysm,Clinicaloutcomesevaluation,Clinicalstatus:mRSPermanentmorbidityandmortalityofthetreatmentwasevaluatedat1month:Morbidity:Asymptomaticaneurysms:mRS25;Symptomaticaneurysms:mRSpreviousmortality:Anydeathwithin30daysofendovasculartreatmentAnatomicalresults:modified3-pointJeanRaymondclassificationscale:completeocclusion,neckremnant,andaneurysmremnant,Descriptionofpatientspopulationandaneurysms,24patients/center649patients:468femalepatients,181malepatients649patientswith1100UIAs,289patientswithmultipleUIAs700procedureswereperformedtotreat739aneurysmsAnteriorcirculation:91.9%Posteriorcirculation:8.1%,results,Parentarteryocclusion:12Coils:727aneurysms396aneurysms:coilsalone271aneurysms:remodelingtechqiuesStenting:57Trispan:3,FeasibilityofEndovascularTreatmentofUnrupturedIntracranialAneurysms:32aneurysmsfailedbyendovascularapproach;2patientswithmultipleUIAs,othersrupturedduringtheprocedure;22becauseofanatomicalreasons:widenecknotcontrollablewiththeremodelingtechnique,vesselarisingfromtheneckoftheaneurysm,andsmallsizeoftheaneurysmmakingdepositionofcoilsdifficultandunsafe8aneurysms:duetotechniqueproblems:difficultiesinmicrocatherplacement14MCAUIAsfailedSize:failurerate:16mm5.7%715mm:2.3%p=0.022Dome-to-neckratio:1.53.1%.P=0.57,104adverseevents:88sepecificadverseevents50ischemicstroke18anerysmsruptured20coilrelatedevents16puncturerelatedevents,Factorsaffectingtheprocedure-relatedproblems,No,significant,significant,No,11patients:(1.7%)6:ischemicstroke4:aneurysmrupture1:UIAsunrelatedhemotoma9death(1.4%)6:diedduringorimmediatelyaftertreatment1:anestheticcomplication2:severaldaysafterthetreatment:intracranialhemotoma,FactorsAffectingComplicationsofEndovascularTreatmentofUnrupturedIntracranialAneurysms:Ischemicstroke:notsignificantlydifferentaccordingtothelocationordome-to-neckratioofaneurysms.Onthecontrary,therateofthromboemboliceventswassignificantlyhigherinlarge-sizedaneurysms(1to6mm:4.6%;7to15mm:9.9%;P0.008).Aneurysmrupture:significantlyhigherinsmalleraneurysms(1to6mm:3.7%;7to15mm:0.7%;P0.008),ComparisonbetweensugeryandEVT,Nodirectcomparisoninarandomizedstudyavailablesingle-centerseriesJohnston(1999):significantlyhigherinthesurgicalgroup(18.5%)thanintheendovasculargroup(10.6%).Mortalitywas2.3%afterclippingand0.4%aftercoilingHigashida(2007):endovasculartreatmentwasassociatedwithfeweradverseoutcomes(6.6%versus13.2%),decreasedmortality(0.9%versus2.5%),limitations,inclusionbiascognitivestatusofthepatientswasnotevaluated,Pierot,L.,L.Spelle,