文献回顾未破裂动脉瘤.pptx

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 Endovascular approach of Non ruptured Aneurysms.Conducted by the French Society of Neuroradiology(SFNR)27 Canadian and French neurointerventional centers.17 monthsPatients and aneurysm critereaaneurysms less than 15 mm.Excluded aneurysms:Fusiform and dissecting aneurysmsaneurysms associated with brain arteriovenous malformationsIn case of recent subarachnoid hemorrhage(1 month)related to another aneurysmClinical outcomes evaluationClinical status:mRSPermanent morbidity and mortality of the treatment was evaluated at 1 month:Morbidity:Asymptomatic aneurysms:mRS 25;Symptomatic aneurysms:mRS previousmortality:Any death within 30 days of endovascular treatmentAnatomical results:modified 3-point Jean Raymond classification scale:complete occlusion,neck remnant,and aneurysm remnantDescription of patients population and aneurysms24 patients/center649 patients:468 female patients,181 male patients649 patients with 1100 UIAs,289 patients with multiple UIAs700 procedures were performed to treat 739 aneurysmsAnterior circulation:91.9%Posterior circulation:8.1%resultsParent artery occlusion:12Coils:727 aneurysms396 aneurysms:coils alone271 aneurysms:remodeling techqiuesStenting:57Trispan:3Feasibility 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 the remodeling technique,vessel arising from the neck of the aneurysm,and small size of the aneurysm making deposition of coils difficult and unsafe8 aneurysms:due to technique problems:difficulties in microcather placement14 MCA UIAs failedSize:failure rate:16mm 5.7%715mm:2.3%p=0.022Dome-to-neck ratio:1.5 3.1%.P=0.57104 adverse events:88 sepecific adverse events50 ischemic stroke18 anerysms ruptured20 coil related events16 puncture related eventsFactors affecting the procedure-related problemsNosignificantsignificantNo11 patients:(1.7%)6:ischemic stroke4:aneurysm rupture1:UIAs unrelated hemotoma9 death(1.4%)6:died during or immediately after treatment1:anesthetic complication2:several days after the treatment:intracranial hemotomaFactors Affecting Complications of Endovascular Treatment of Unruptured Intracranial Aneurysms:Ischemic stroke:not 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 6 mm:3.7%;7 to 15 mm:0.7%;P0.008)Comparison between sugery and EVTNo direct comparison in a randomized study availablesingle-center seriesJohnston(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 coilingHigashida(2007):endovascular treatment was associated with fewer adverse outcomes(6.6%versus 13.2%),decreased mortality(0.9%versus 2.5%)limitationsinclusion biascognitive status of the patients was not evaluatedPierot,L.,L.Spelle,and F.Vitry,Immediate anatomic results after the endovascular treatment of unruptured intracranial aneurysms:analysis of the ATENA series.AJNR Am J Neuroradiol,2010.31(1):p.140-4.