支架辅助盘绕与编织桥内栓塞治疗未破裂宽颈分岔颅内动脉瘤的比较分析：倾向评分匹配研究

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-04-04 DOI:10.1016/j.jocn.2025.111204

Kyu Seon Chung, Solbi Kim, Hyun Jin Han, Keun Young Park, Yong Bae Kim, Jung-Jae Kim

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引用次数: 0

摘要

背景：在使用Woven EndoBridge （WEB）治疗宽颈分岔颅内动脉瘤（WNBA）之前，支架辅助盘绕（SAC）是主要的血管内治疗方法。直接比较这两种方法的结果的研究仍然有限。本研究旨在通过倾向评分匹配比较SAC和WEB栓塞治疗未破裂WNBAs的安全性和有效性。方法本回顾性研究纳入2014年1月至2023年6月在同一医院接受SAC或WEB治疗的未破裂WNBAs患者。根据患者和动脉瘤特征进行倾向评分匹配。比较匹配组的围手术期事件和6个月的临床和放射学结果，分别使用改进的Rankin量表和Raymond-Roy闭塞分类进行评估。结果286例患者中，经倾向评分匹配后，每组纳入74例。WEB组透视时间明显短于SAC组(p <；0.001)。围手术期并发症主要包括术中血栓栓塞事件，SAC组9例（12.2%），WEB组5例（6.8%）（p = 0.388）。在6个月的随访期间，SAC患者的出血发生率明显高于SAC患者（8例，10.8%）。SAC组和WEB组的6个月完全咬合率分别为85.9%和77.5% (p = 0.309)，而两组的充分咬合率分别为91.5%和90.1% （p = 1.000）。结论WEB和SAC治疗未破裂WNBAs的6个月临床和影像学结果具有可比性。WEB比SAC有优势，包括减少透视时间和避免双重抗血小板治疗。摘要在应用Woven EndoBridge （WEB）治疗宽颈分叉性颅内动脉瘤（WNBA）之前，支架辅助盘绕（SAC）是主要的血管内治疗方法。直接比较这两种方法的结果的研究仍然有限。本研究旨在通过倾向评分匹配比较SAC和WEB栓塞治疗未破裂WNBAs的安全性和有效性。该回顾性研究纳入了2014年1月至2023年6月在同一家机构接受SAC或WEB治疗的未破裂WNBAs患者。根据患者和动脉瘤特征进行倾向评分匹配。比较匹配组的围手术期事件和6个月的临床和放射学结果，分别使用改进的Rankin量表和Raymond-Roy闭塞分类进行评估。286例患者中，经倾向评分匹配后，每组74例。WEB组透视时间明显短于SAC组(p <；0.001)。围手术期并发症主要包括术中血栓栓塞事件，SAC组9例（12.2%），WEB组5例（6.8%）（p = 0.388）。在6个月的随访期间，SAC患者的出血发生率明显高于SAC患者（8例，10.8%）。SAC组和WEB组的6个月完全咬合率分别为85.9%和77.5% (p = 0.309)，而两组的充分咬合率分别为91.5%和90.1% （p = 1.000）。WEB和SAC治疗未破裂WNBAs的6个月临床和放射学结果具有可比性。WEB比SAC有优势，包括减少透视时间和避免双重抗血小板治疗。

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Comparative analysis between stent-assisted coiling and Woven EndoBridge embolization for unruptured wide-necked bifurcation intracranial aneurysms: A propensity score matching study

Background

Methods

This retrospective study included patients treated with SAC or WEB for unruptured WNBAs at a single institution between January 2014 and June 2023. Propensity score matching was conducted based on patient and aneurysm characteristics. The matched groups were compared for periprocedural events and 6-month clinical and radiological outcomes, assessed using the modified Rankin Scale and Raymond-Roy occlusion classification, respectively.

Results

Among 286 patients, 74 were included in each group after propensity score matching. The WEB group exhibited significantly shorter fluoroscopy time than the SAC group (p < 0.001). Periprocedural complications primarily comprised intraoperative thromboembolic events, with nine cases (12.2 %) in the SAC group and five cases (6.8 %) in the WEB group (p = 0.388). Throughout the 6-month follow-up period, nuisance bleeding occurred significantly more frequently in patients with SAC (8 cases, 10.8 %). The 6-month complete occlusion rates were 85.9 % and 77.5 % for the SAC and WEB groups, respectively (p = 0.309), whereas adequate occlusion rates were 91.5 % and 90.1 % for the groups, respectively (p = 1.000).

Conclusions

The 6-month clinical and radiological outcomes of unruptured WNBAs treated with WEB and SAC were comparable. WEB has advantages over SAC, including reduced fluoroscopy time and avoidance of dual antiplatelet therapy.

Abstract

Before the utilization of the Woven EndoBridge (WEB) for the treatment of wide-necked bifurcation intracranial aneurysms (WNBA), stent-assisted coiling (SAC) was the predominant endovascular treatment. Studies directly comparing the outcomes of these two methods are still limited. This study aimed to compare the safety and efficacy of SAC and WEB embolization for unruptured WNBAs through propensity score matching. This retrospective study included patients treated with SAC or WEB for unruptured WNBAs at a single institution between January 2014 and June 2023. Propensity score matching was conducted based on patient and aneurysm characteristics. The matched groups were compared for periprocedural events and 6-month clinical and radiological outcomes, assessed using the modified Rankin Scale and Raymond-Roy occlusion classification, respectively. Among 286 patients, 74 were included in each group after propensity score matching. The WEB group exhibited significantly shorter fluoroscopy time than the SAC group (p < 0.001). Periprocedural complications primarily comprised intraoperative thromboembolic events, with nine cases (12.2 %) in the SAC group and five cases (6.8 %) in the WEB group (p = 0.388). Throughout the 6-month follow-up period, nuisance bleeding occurred significantly more frequently in patients with SAC (8 cases, 10.8 %). The 6-month complete occlusion rates were 85.9 % and 77.5 % for the SAC and WEB groups, respectively (p = 0.309), whereas adequate occlusion rates were 91.5 % and 90.1 % for the groups, respectively (p = 1.000). The 6-month clinical and radiological outcomes of unruptured WNBAs treated with WEB and SAC were comparable. WEB has advantages over SAC, including reduced fluoroscopy time and avoidance of dual antiplatelet therapy.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.