Residuals, recurrences and re-treatment after endovascular repair of intracranial aneurysms: A retrospective methodological comparison.

Autor:	Froelich JJ; Department of Medical Imaging and Interventional Neuroradiology, Royal Hobart Hospital, Hobart, Australia.; Medical Science Precinct, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia., Cheung N; Department of Medical Imaging and Interventional Neuroradiology, Royal Hobart Hospital, Hobart, Australia.; Medical Science Precinct, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia., de Lange JA; Department of Medical Imaging and Interventional Neuroradiology, Royal Hobart Hospital, Hobart, Australia., Monkhorst J; Department of Medical Imaging and Interventional Neuroradiology, Royal Hobart Hospital, Hobart, Australia., Carr MW; Department of Medical Imaging and Interventional Neuroradiology, Royal Hobart Hospital, Hobart, Australia., DeLeacy R; Department of Neurosurgery, Cerebrovascular Center, Mount Sinai Hospital, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2020 Feb; Vol. 26 (1), pp. 45-54. Date of Electronic Publication: 2019 Aug 12.
DOI:	10.1177/1591019919867841
Abstrakt:	Objective: Incomplete aneurysm occlusions and re-treatment rates of 52 and 10-30%, respectively, have been reported following endovascular treatment of intracranial aneurysms, raising clinical concerns regarding procedural efficacy. We compare residual, recurrence and re-treatment rates subject to different endovascular techniques in both ruptured and unruptured intracranial aneurysms at a comprehensive state-wide tertiary neurovascular centre in Australia. Methods: Medical records, procedural and follow-up imaging studies of all patients who underwent endovascular treatment for intracranial aneurysms between July 2010 and July 2017 were reviewed retrospectively. Residuals, recurrences and re-treatment rates were assessed regarding initial aneurysm rupture status and applied endovascular technique: primary coiling, balloon- and stent-assisted coiling and flow diversion. Results: Among 233 aneurysms, residual, recurrence and re-treatment rates were 27, 11.2 and 9.4%, respectively. Compared with unruptured aneurysms, similar residual and recurrence (p > .05), but higher re-treatment rates (4.5% vs. 19%; p < .001) were found for ruptured aneurysms. Residual, recurrence and re-treatment rates were: 13.3, 16 and 12% for primary coiling; 12, 12 and 10.7% for balloon-assisted coiling; 14.9, 7.5 and 4.5% for stent-assisted coiling; 91.9, 0 and 5.4% for flow diversion. Stent-assistance and flow-diversion were associated with lower recurrence and re-treatment rates, when compared with primary- and balloon-assisted coiling (p < .05). Conclusions: Residuals and recurrences after endovascular treatment of intracranial aneurysms are less common than previously reported. Stent assistance and flow diversion seem associated with reduced recurrence- and re-treatment rates, when compared with primary- and balloon-assisted coiling. Restrained use of stents in ruptured aneurysms may be a contributing factor for higher recurrence/retreatment rates compared to unruptured aneurysms.
Databáze:	MEDLINE
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