文献回顾-未破裂动脉瘤.ppt

1、Review of published papers,Hu Peng 2010-7-20,Pierot, L., L. Spelle, and F. Vitry, Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke, 2008. 39(9): p. 2497-504.,ATENA: Analysis of Treatment by Endovas

2、cular approach of Non ruptured Aneurysms. Conducted by the French Society of Neuroradiology (SFNR) 27 Canadian and French neurointerventional centers. 17 months,Patients and aneurysm criterea,aneurysms less than 15 mm. Excluded aneurysms: Fusiform and dissecting aneurysms aneurysms associated with b

3、rain arteriovenous malformations In case of recent subarachnoid hemorrhage (1 month) related to another aneurysm,Clinical outcomes evaluation,Clinical status: mRS Permanent morbidity and mortality of the treatment was evaluated at 1 month: Morbidity: Asymptomatic aneurysms: mRS 25; Symptomatic aneur

4、ysms: mRS previous mortality: Any death within 30 days of endovascular treatment Anatomical results: modified 3-point Jean Raymond classification scale: complete occlusion, neck remnant, and aneurysm remnant,Description of patients population and aneurysms,24 patients/center 649 patients: 468 female

5、 patients, 181 male patients 649 patients with 1100 UIAs, 289 patients with multiple UIAs 700 procedures were performed to treat 739 aneurysms Anterior circulation: 91.9% Posterior circulation: 8.1%,results,Parent artery occlusion: 12 Coils: 727 aneurysms 396 aneurysms: coils alone 271 aneurysms: re

6、modeling techqiues Stenting: 57 Trispan: 3,Feasibility of Endovascular Treatment of Unruptured Intracranial Aneurysms: 32 aneurysms failed by endovascular approach; 2 patients with multiple UIAs, others ruptured during the procedure; 22 because of anatomical reasons: wide neck not controllable with

7、the remodeling technique, vessel arising from the neck of the aneurysm, and small size of the aneurysm making deposition of coils difficult and unsafe 8 aneurysms: due to technique problems: difficulties in microcather placement 14 MCA UIAs failed Size: failure rate: 16mm 5.7% 715mm: 2.3% p=0.022 Do

8、me-to-neck ratio: 1.5 3.1%. P=0.57,104 adverse events: 88 sepecific adverse events 50 ischemic stroke 18 anerysms ruptured 20 coil related events 16 puncture related events,Factors affecting the procedure-related problems,No,significant,significant,No,11 patients: (1.7%) 6: ischemic stroke 4: aneury

9、sm rupture 1: UIAs unrelated hemotoma 9 death (1.4%) 6: died during or immediately after treatment 1: anesthetic complication 2: several days after the treatment: intracranial hemotoma,Factors Affecting Complications of Endovascular Treatment of Unruptured Intracranial Aneurysms: Ischemic stroke: no

10、t significantly different according to the location or dome-to-neck ratio of aneurysms. On the contrary, the rate of thromboembolic events was significantly higher in large-sized aneurysms (1 to 6 mm: 4.6%; 7 to 15 mm: 9.9%; P 0.008). Aneurysm rupture: significantly higher in smaller aneurysms (1 to

11、 6 mm: 3.7%; 7 to 15 mm: 0.7%; P0.008),Comparison between sugery and EVT,No direct comparison in a randomized study available single-center series Johnston(1999): significantly higher in the surgical group (18.5%) than in the endovascular group (10.6%). Mortality was 2.3% after clipping and 0.4% after coiling Higashida(2007): endovascular treatment was associated with fewer adverse outcomes (6.6% versus 13.2%), decreased mortality (0.9% versus 2.5%),limitations,inclusion bias cognitive status of the patients was not evaluated,Pierot, L., L. Spelle, a