Stent-assisted embolization of acutely rupture wide-necked intracranial aneurysms: complication and efficacy

doi:10.3877/cma.j.issn.2095-9141.2017.06.004

Abstract

Abstract:

Objective

To evaluate the safety and angiographic and clinical outcome of stent-assisted coil placement for acutely ruptured wide-necked intracranial aneurysms treated in a single center.

Methods

A total of 52 rupture wide-necked aneurysms that were treated with stent-assisted coiling from January 2011 to December 2015 were reviewed retrospectively at our institution. Data collected and analyzed included: patient demographics; morphologic features of the aneurysm; treatment results and follow-up results.

Results

There were 5 (9.6%) overall procedure-related complications in 52 patients, including: 1 intraprocedural aneurysm ruptures, 1 postoperative hemorrhage, 2 thromboembolic complications. In a logistic regression analysis, the complications differed significantly in the patients with high Hunt-Hess grade (OR=18.09, 95%CI: 1.03-316.61, P=0.047), high mFisher grade (OR=10.25, 95%CI: 1.41-75.51, P=0.021). Favorable outcomes were seen in 37 of those patients in along-term follow-up.

Conclusion

Stent-assisted coiling of ruptured wide-necked intracranial aneurysms is effective, and provides durable aneurysm closure. High Hunt-Hess grade and mFisher grade is association with significantly higher complication rates.

Key words: Wide-necked Intracranial aneurysms, Stent-assisted embolization, Rupture

Xiaodong Wang, Zhaowei Qin. Stent-assisted embolization of acutely rupture wide-necked intracranial aneurysms: complication and efficacy[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2017, 03(06): 335-342.

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References 31

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变量		所有病例(n=52)	并发症组(n=5)	无并发症组(n=47)	t/χ²值	P值
年龄（岁，均数±标准差）		55.142±9.576	62.628±1.954	54.328±9.745	1.901	0.064
男性		15(28.846)	0(0)	15(31.914)	0.060	0.831
高血压		5(9.615)	4(80)	1(2.128)	7.921	0.015
动脉瘤部位		?	?	?	0.388	0.473
?	前循环	47(90.384)	4(80)	43(91.489)	?	?
?	后循环	5(9.616)	1(20)	4(8.511)	?	?
动脉瘤大小		?	?	?	5.122	0.095
?	小（直径	18(34.615)	4(80)	14(29.787)	?	?
?	中（直径5~10 mm）	27(51.923)	1(20)	26(55.319)	?	?
?	大（直径>10 mm）	7(13.462)	0(0)	7(14.894)	?	?
使用支架类型		?	?	?	1.660	0.424
?	Enterprise	32(61.538)	4(80)	28(59.574)	?	?
?	Neuroform	12(23.076)	0(0)	12(25.531)	?	?
?	Solitaire	8(15.386)	1(20)	7(14.895)	?	?
先置入支架		44(84.615)	2(40)	42(89.361)	8.459	0.022
Hunt-Hess分级		?	?	?	15.191	0.002
?	高级别	9(17.307)	4(80)	5(10.638)	?	?
?	低级别	43(82.693)	1(20)	42(89.262)	?	?
mFisher分级		?	?	?	7.045	0.031
?	高级别	9(17.307)	3(60)	6(12.765)	?	?
?	低级别	43(82.693)	2(40)	41(87.235)	?	?

变量		所有病例(n=52)	并发症组(n=5)	无并发症组(n=47)	t/χ²值	P值
年龄（岁，均数±标准差）		55.142±9.576	62.628±1.954	54.328±9.745	1.901	0.064
男性		15(28.846)	0(0)	15(31.914)	0.060	0.831
高血压		5(9.615)	4(80)	1(2.128)	7.921	0.015
动脉瘤部位		?	?	?	0.388	0.473
?	前循环	47(90.384)	4(80)	43(91.489)	?	?
?	后循环	5(9.616)	1(20)	4(8.511)	?	?
动脉瘤大小		?	?	?	5.122	0.095
?	小（直径	18(34.615)	4(80)	14(29.787)	?	?
?	中（直径5~10 mm）	27(51.923)	1(20)	26(55.319)	?	?
?	大（直径>10 mm）	7(13.462)	0(0)	7(14.894)	?	?
使用支架类型		?	?	?	1.660	0.424
?	Enterprise	32(61.538)	4(80)	28(59.574)	?	?
?	Neuroform	12(23.076)	0(0)	12(25.531)	?	?
?	Solitaire	8(15.386)	1(20)	7(14.895)	?	?
先置入支架		44(84.615)	2(40)	42(89.361)	8.459	0.022
Hunt-Hess分级		?	?	?	15.191	0.002
?	高级别	9(17.307)	4(80)	5(10.638)	?	?
?	低级别	43(82.693)	1(20)	42(89.262)	?	?
mFisher分级		?	?	?	7.045	0.031
?	高级别	9(17.307)	3(60)	6(12.765)	?	?
?	低级别	43(82.693)	2(40)	41(87.235)	?	?

变量	OR	95%CI	P值
Hunt-Hess分级	18.091	1.031~316.614	0.047
mFisher分级	10.257	1.415~74.525	0.021
高血压	3.423	0.208~57.737	0.394
先置入支架	8.706	0.575~133.791	0.121

变量	OR	95%CI	P值
Hunt-Hess分级	18.091	1.031~316.614	0.047
mFisher分级	10.257	1.415~74.525	0.021
高血压	3.423	0.208~57.737	0.394
先置入支架	8.706	0.575~133.791	0.121

变量		复发组(n=4)	未复发组(n=35)	t/χ²值	P值
年龄（岁，均数±标准差）		61.531±15.426	53.769±9.237	1.912	0.145
男性		0(0)	12(34.285)	1.985	0.292
动脉瘤部位		?	?	0.66	0.636
?	前循环	4(100)	30(85.714)	?	?
?	后循环	0(0)	5(14.285)	?	?
动脉瘤大小		?	?	3.084	0.105
?	小（直径	0(0)	14(40)	?	?
?	中（直径10~24 mm）	3(75)	19(54.286)	?	?
?	大（直径>24 mm）	1(25)	2(5.714)	?	?
使用支架类型		?	?	1.980	0.424
?	Enterprise	4(100)	23(65.714)	?	?
?	Neuroform	0(0)	7(20)	?	?
?	Solitaire	0(0)	5(14.286)	?	?
先置入支架		4(100)	29(82.857)	0.817	0.602
Hunt-Hess分级		?	?	4.107	0.104
?	高级别	2(50)	4(11.428)	?	?
?	低级别	2(50)	31(88.572)	?	?
mFisher分级		?	?	0.056	0.991
?	高级别	1(25)	7(20)	?	?
?	低级别	3(75)	28(80)	?	?

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