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Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms.

抗血小板治疗预防未破裂脑动脉瘤弹簧圈手术中血栓栓塞并发症。

  • 影响因子:2.98
  • DOI:10.1136/neurintsurg-2019-015173
  • 作者列表:"Almekhlafi MA","Al Sultan AS","Kuczynski AM","Brinjikji W","Menon BK","Hill MD","Goyal M
  • 发表时间:2020-03-01
Abstract

BACKGROUND AND PURPOSE:Thromboembolic events are recognized complications of aneurysm coiling. OBJECTIVE:To identify any protective effects of antiplatelet therapy use before coiling of unruptured aneurysms. METHODS:We conducted a meta-analysis of clinical studies published up to February 2019. We included studies reporting symptomatic thromboembolic events (defined as clinical stroke or transient ischemic attacks) in patients who received antiplatelet therapy before coiling of unruptured aneurysms using unassisted coiling, balloon assistance, or multiple microcatheters. We excluded ruptured aneurysms and those treated with stent coiling or flow diverters. RESULTS:We identified 14 studies (2486 patients). All were single-center studies and four were prospective. In three studies with a control (no treatment) arm, the pooled risk ratio for symptomatic thromboembolic events with versus without antiplatelet therapy was 0.33 (95% CI 0.17 to 0.92, p= 0.035). The cumulative risk of symptomatic thromboembolic events with single antiplatelet agents was 5.0% '56/1122' (95% CI 1.6% to 8.4%, I283.63%), and with dual or multiple agents 2.7% '33/1237' (95% CI 1.0% to 3.0%, I239.9%). The incidence of diffusion lesions was reported in seven studies. It was 50.5% '96/190' (95% CI 7.3% to 93.9%, I294.4%) with single agents compared with 43.9% '196/446' (95% CI 25.9% to 61.9%, I273.4%) with dual or multiple agents. CONCLUSION:Periprocedural antiplatelet therapy was associated with a low symptomatic thromboembolic event after coiling-only for unruptured aneurysms. However, available evidence is of limited quality with significant heterogeneity, requiring evidence from randomized controlled trials.

摘要

背景和目的: 血栓栓塞事件是公认的动脉瘤栓塞并发症。 目的: 确定未破裂动脉瘤栓塞术前使用抗血小板治疗的任何保护作用。 方法: 我们对截至2019年2月发表的临床研究进行了荟萃分析。我们纳入的研究报告了在未破裂动脉瘤使用非辅助弹簧圈、球囊辅助或多个微导管进行弹簧圈治疗前接受抗血小板治疗的患者中出现症状性血栓栓塞事件 (定义为临床卒中或短暂性脑缺血发作)。我们排除了破裂的动脉瘤和支架弹簧圈或分流器治疗的动脉瘤。 结果: 我们确定了14项研究 (2486例患者)。所有研究均为单中心研究,4项为前瞻性研究。在3项对照 (无治疗) 研究中,抗血小板治疗与未抗血小板治疗的症状性血栓栓塞事件的合并风险比为0.33 (95% CI 0.17 to 0.92,p = 0.035)。使用单一抗血小板药物的症状性血栓栓塞事件的累积风险为5.0% '56/1122' (95% ci 1.6% ~ 8.4%,I283.63 %),使用双重或多重药物的累积风险为2.7% '33/1237' (95% ci 1.0% ~ 3.0%,I239.9 %)。在7项研究中报告了扩散性病变的发生率。单药为50.5% '96/190' (95% ci 7.3% ~ 93.9%,I294.4 %),双药或多药为43.9% '196/446' (95% ci 25.9% ~ 61.9%,I273.4 %)。 结论: 围手术期抗血小板治疗与仅针对未破裂动脉瘤的弹簧圈栓塞术后低症状性血栓栓塞事件相关。然而,现有证据的质量有限,具有显著的异质性,需要来自随机对照试验的证据。

关键词: 动脉瘤 线圈 栓塞
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影响因子:1.05
发表时间:2020-02-01
DOI:10.23736/S0021-9509.18.10206-0
作者列表:["Peters AS","Hatzl J","Bischoff MS","Böckler D"]

METHODS:BACKGROUND:Due to recent advances in endograft design and percutaneous access, technical success could be increased during endovascular aneurysm repair (EVAR). Beside EVAR, endovascular aneurysm sealing (EVAS) provides an alternative procedure to treat aneurysms. To compare the two methods, additional benchmark criteria should be evaluated: Screening time, dose area product (DAP), procedure time and contrast use. In this study these technical variables are analyzed for EVAS vs. EVAR in comparable patient cohorts. METHODS:It is a retrospective, single-center study. Only elective cases of infrarenal aortic aneurysms were included, all treated by the same surgeon (D.B.). Procedures were performed within the instructions for use without additional procedures. All operations were undertaken in a hybrid operating theatre. For EVAR, only the Medtronic Endurant® and the Gore C3 Excluder® were included. For EVAS the Nellix® from Endologix was used. RESULTS:Between 2012 and 2016, 67 patients were treated with EVAS and 40 with EVAR; of these 20 and 16 could be introduced into the study respectively. Median age was 73 and 72 years respectively (only men). The two groups were comparable in terms of BMI, GFR and ASA-status. Screening time was reduced for EVAS (10.6 vs. 14.5 min., P<0.01), while the DAP was not significantly different. Procedural time and contrast use were increased for EVAS (120 vs. 96 min., 120 vs. 79 mL, P<0.01). CONCLUSIONS:Especially the younger EVAS-procedure requires ongoing review in order to further reduce contrast agent. Reduced screening time for EVAS does not have a significant impact on radiation dose.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:4.91
发表时间:2020-04-01
来源期刊:Annals of surgery
DOI:10.1097/SLA.0000000000003050
作者列表:["Karthaus EG","Vahl A","van der Werf LR","Elsman BHP","Van Herwaarden JA","Wouters MWJM","Hamming JF"]

METHODS:OBJECTIVE:To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. BACKGROUND:Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation. METHODS:All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage. RESULTS:In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation. CONCLUSIONS:Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:1.05
发表时间:2020-04-01
DOI:10.23736/S0021-9509.18.10639-2
作者列表:["Kodama H","Takahashi S","Okazaki T","Morita S","Go S","Watanabe M","Yamane Y","Katayama K","Kurosaki T","Sueda T"]

METHODS:BACKGROUND:Spinal cord ischemia (SCI) and paraplegia are complications of surgery for type A acute aortic dissection (TAAAD). Since the segmental arteries play a key role in SCI, this study evaluated the association between SCI and false lumen segmental arteries (FLSAs: segmental arteries originating from the false lumen). METHODS:The study included 101 consecutive TAAAD patients (mean age, 66±13; range, 34-89 years) who underwent surgery from January 2011 to April 2017. The diagnosis of TAAAD and the number of FSLAs were determined by preoperative computed tomography (CT). Patients were divided into two groups according to the number of FLSAs at the Th9-L2 level: Group A (N.=13), ≥8 FLSAs; and group B (N.=88), ≤7 FLSAs. Preoperative, perioperative, and postoperative findings were compared between the groups, and risk factors for SCI were evaluated. RESULTS:The frequency of preoperative paralysis was significantly higher in Group A than Group B (P=.0070). The overall incidence of postoperative SCI was 8% (8/101) and significantly higher in Group A than Group B (5/13 [45%] vs. 3/88 (4%), P<0.0001). Hospital mortality was 8% (8/101) and significantly higher in Group A than Group B (3/13 [23%] vs. 5/88 [6%], P=.0302). Multivariate analysis showed that the independent risk factors for SCI were ≥8 FLSAs at Th9-L2 (odds ratio [OR], 20.4; 95% confidence interval [95% CI], 3.34-124.9, P=0.0011) and diabetes mellitus (OR, 22.3; 95% CI, 1.69-294.5; P=0.0184). CONCLUSIONS:In patients who underwent surgery for TAAAD, ≥8 FLSAs at the Th9-L2 levels on preoperative CT was a risk factor for SCI.

关键词: 暂无
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动脉瘤方向

动脉瘤是由于动脉壁的病变或损伤,形成动脉壁局限性或弥漫性扩张或膨出,以膨胀性、搏动性肿块为主要表现,可以发生在动脉系统的任何部位,而以肢体主干动脉、主动脉和颈动脉较为常见。

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