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Outcome of retreatment for recurrent saccular cerebral aneurysms: a propensity score-matched analysis.

复发性囊性脑动脉瘤再治疗的结局: 倾向评分匹配分析。

  • 影响因子:2.04
  • DOI:10.1007/s10143-020-01259-6
  • 作者列表:"Matsukawa H","Tanikawa R","Kamiyama H","Noda K","Uchida K","Shirakawa M","Yoshimura S
  • 发表时间:2020-02-21
Abstract

:Although endovascular or surgical treatment has been performed for preventing the rupture of saccular cerebral aneurysms (sCA), in some patients, the aneurysms may recur and require retreatment. We aimed to investigate the clinical and radiological outcomes of treating recurrent sCA. We retrospectively evaluated the data of 52 patients with 60 recurrent sCAs who were retreated and 1534 patients with 1817 sCAs who received initial treatment. The primary outcome was a recurrence of the aneurysm. Secondary outcomes were an additional treatment, rupture after treatment, and a neurological worsening, which was defined as an increase of 1 or more scores using the modified Rankin Scale at 12-month. Safety outcomes included postoperative ischemic and hemorrhagic complications. We compiled the 120 (60 each) propensity score-matched cohort based on a propensity score for the treatment of recurrent sCA. In the propensity score-matched cohort, recurrence after treatment was observed in 25% and 6.7% of cases in the retreatment and initial treatment groups, respectively. The odds ratio of recurrence after treatment was 4.7 (95% CI, 1.4-15; P = 0.011). The secondary and safety outcomes were not significantly different between the two groups. This study showed that the treatment of recurrent sCA was a risk factor for recurrence after treatment but not for additional treatment, rupture after treatment, or neurological worsening. Although decision-making regarding the treatment varies depending on the institutional protocols and personal experience of the physicians, endovascular or surgical retreatment could be performed without hesitation.

摘要

: 虽然已经进行了血管内或手术治疗以防止囊性脑动脉瘤 (sCA) 破裂,但在一些患者中,动脉瘤可能会复发并需要再次治疗。我们旨在研究治疗复发性 sCA 的临床和放射学结局。我们回顾性评估了 52 例 60 例复发 sCAs 患者复治和 1534 例 1817 例 sCAs 初始治疗的资料。主要结果是动脉瘤复发。次要结局是额外治疗、治疗后破裂和神经功能恶化,定义为 12 个月时使用改良 Rankin 量表增加 1 个或更多评分。安全性结局包括术后缺血性和出血性并发症。我们根据治疗复发性 sCA 的倾向评分汇编了 120 (每个 60) 个倾向评分匹配队列。在倾向评分匹配的队列中,再治疗组和初始治疗组分别有 25% 和 6.7% 的病例观察到治疗后复发。治疗后复发的比值比为 4.7 (95% CI,1.4 ~ 15; p = 0.011)。两组的次要和安全性结局无显著差异。本研究表明,复发性 sCA 的治疗是治疗后复发的危险因素,但不是额外治疗、治疗后破裂或神经功能恶化的危险因素。虽然关于治疗的决策因医生的机构方案和个人经验而异,但可以毫不犹豫地进行血管内或外科再治疗。

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