The safety and efficacy of stent-assisted coiling for acutely ruptured cerebral aneurysms: a multicenter prospective registry study (SAVE).

IF 12.5 2区 医学 Q1 SURGERY
Gaozhi Li, Shenghao Ding, Jiale Wang, Kuang Zheng, Wenshuai Li, Guohua Mao, Xiaobo Liu, Zheming Zhang, Dianshi Jin, Lang Liu, Qinhua Guo, Qingyuan Liu, Xiaohua Zhang, Edgar Samaniego, Rose Du, Yaohua Pan, Jieqing Wan, Bing Zhao
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引用次数: 0

Abstract

Background: Stent-assisted coiling (SAC) is a reasonable treatment for ruptured cerebral aneurysms that are not amenable to primary coiling. However, the safety and efficacy of SAC for acutely ruptured cerebral aneurysms need to be further determined.

Purpose: To evaluate the safety and efficacy of SAC for acutely ruptured cerebral aneurysms.

Methods: This was a prospective, multicenter study of consecutive patients with acutely ruptured cerebral aneurysms treated with SAC within 72 hours after presentation. The primary outcome was treatment-related thromboembolic complications within 30 days of treatment; the secondary outcomes were hemorrhagic complications and aneurysm recurrence. A favorable clinical outcome was defined as a modified Rankin scale (mRS) of 0 to 2 at 6 months after treatment.

Results: Of the 315 patients, 278 patients with 278 acutely ruptured aneurysms were included in the study. Treatment-related thromboembolic complications occurred in 32 patients (11.5%), including nine (3.2%) patients with intraoperative thrombosis and 23 (8.3%) patients with postoperative ischemia. Hemorrhagic complications occurred in 13 (4.7%) patients, including one (0.4%) patient with intraoperative hemorrhage and 12 (4.3%) patients with postoperative hemorrhage. Aneurysm rebleeding occurred in two (0.7%) patients. A total of 251 (251/275, 91.3%) patients had favorable clinical outcomes at the 6-month follow-up. The rate of aneurysm recurrence was 7.2%. Patients with a worse WFNS grade tended to have thromboembolic complications (21.2% vs. 10.2%, P = 0.079) and hemorrhagic complications (12.1% vs. 3.7%, P = 0.054). Treatment-related thromboembolic complications and hemorrhagic complications were independent predictors of unfavorable clinical outcomes.

Conclusions: Most patients had favorable clinical outcomes, with a low risk of intraoperative complications, aneurysm rebleeding, and a high rate of aneurysm occlusion. SAC for acutely ruptured aneurysms is a safe and effective procedure, especially in patients with good clinical conditions before treatment.

支架辅助卷曲治疗急性脑动脉瘤破裂的安全性和有效性:一项多中心前瞻性注册研究(SAVE)。
背景:支架辅助卷绕(SAC)是一种合理的治疗方法,适用于不能进行初次卷绕的脑动脉瘤破裂。然而,SAC治疗急性脑动脉瘤破裂的安全性和有效性有待进一步确定。目的:评价SAC治疗急性脑动脉瘤破裂的安全性和有效性。方法:这是一项前瞻性、多中心研究,研究对象是急性脑动脉瘤破裂后72小时内连续接受SAC治疗的患者。主要终点是治疗后30天内与治疗相关的血栓栓塞并发症;次要结果为出血性并发症和动脉瘤复发。治疗后6个月的改良Rankin评分(mRS)为0 - 2,即为良好的临床结果。结果:315例患者中,278例急性破裂动脉瘤纳入研究。治疗相关血栓栓塞并发症32例(11.5%),其中术中血栓形成9例(3.2%),术后缺血23例(8.3%)。13例(4.7%)患者出现出血性并发症,其中术中出血1例(0.4%),术后出血12例(4.3%)。动脉瘤再出血2例(0.7%)。在6个月的随访中,共有251例(251/275,91.3%)患者临床预后良好。动脉瘤复发率为7.2%。WFNS评分较差的患者往往有血栓栓塞并发症(21.2%比10.2%,P = 0.079)和出血性并发症(12.1%比3.7%,P = 0.054)。治疗相关的血栓栓塞并发症和出血性并发症是不良临床结果的独立预测因素。结论:大多数患者临床预后良好,术中并发症、动脉瘤再出血风险低,动脉瘤闭塞率高。对于急性破裂动脉瘤,SAC是一种安全有效的治疗方法,特别是在治疗前临床条件良好的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
17.70
自引率
3.30%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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