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Clinical and Radiological Outcomes of Intracranial Aneurysm Clipping Aided by Transit Time Flowmetry.

通过时间血流计辅助颅内动脉瘤夹闭术的临床和放射学结局。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2020.01.139
  • 作者列表:"Van Lanen RHGJ","Jacobi-Postma LAA","Veersema TJ","Teernstra OPM","Dings JTA
  • 发表时间:2020-01-26
Abstract

BACKGROUND:Since the International Subarachnoid Aneurysm Trial, coiling has been favored over clipping for intracranial aneurysms, resulting in selection of increasingly complex aneurysm configurations for clipping. We present the outcomes of clipping of aneurysms not suitable for coiling, with transit time flowmetry technology to aid monitoring of intraoperative flow. METHODS:All consecutive patients surgically treated for intracranial aneurysms were included. We assessed intraoperative arterial blood flow in relation to postoperative ischemia and unfavorable outcome (modified Rankin Scale score 3-6), along with radiological occlusion rate, at 6 months and 1 year after surgery. RESULTS:Mortality at 1 year was 7.9%, with a 21.6% rate of an unfavorable outcome. Almost all (96.1%) of patients with unruptured aneurysms had an favorable outcome at 1 year, compared with 71.9% of patients with aneurysmal subarachnoid hemorrhage. Postoperative computed tomography imaging showed an 86.7% occlusion rate and a 7.5% rate of clip-related ischemia. Flow <40% of baseline significantly predicted clip-related ischemia (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.41-8.4; P = 0.012). Clip reposition aided by transit time flowmetry resulted in restored flow >50% above baseline flow in 85.7% of aneurysms. Less than 50% flow from baseline was an independent predictor of unfavorable outcome (OR, 3.85; 95% CI, 1.6-9.0; P = 0.001), along other risk factors. CONCLUSION:In this study of clinical and radiological outcomes of surgically treated cerebral aneurysms not suitable for unassisted coiling, we showed positive results for these challenging aneurysms, aided by transit time flowmetry as a valuable tool, providingquantitative measurements of arterial blood flow to help achieve optimal clip placement and minimizing aneurysm residuals that may be sites of rebleeding. Adequate flow, defined as ≥50% of baseline, greatly reduces the risk of unfavorable outcome.

摘要

背景: 自国际蛛网膜下动脉瘤试验以来,弹簧圈栓塞术一直被青睐于颅内动脉瘤的夹闭术,导致越来越复杂的动脉瘤构型被选择用于夹闭术。我们介绍了不适合弹簧圈栓塞的动脉瘤夹闭的结局,采用了传输时间流量测定技术来帮助监测术中流量。 方法: 纳入所有因颅内动脉瘤手术治疗的连续患者。我们评估了术中动脉血流与术后缺血和不良结局的关系 (改良 Rankin 量表评分 3-6),以及术后 6 个月和 1 年的放射学闭塞率。 结果: 1 年死亡率为 7.9%,不良结局率为 21.6%。与 96.1% 的动脉瘤性蛛网膜下腔出血患者相比,几乎所有 (71.9%) 的未破裂动脉瘤患者在 1 年时有良好的预后。术后计算机断层扫描成像显示 86.7% 的闭塞率和 7.5% 的夹相关缺血率。50% 的动脉瘤中流量高于基线流量 85.7%。相对于基线流量小于 50% 是不良结局的独立预测因子 (OR,3.85; 95% CI,1.6-9.0; P = 0.001) 以及其他危险因素。 结论: 在这项不适合非辅助弹簧圈栓塞手术治疗的脑动脉瘤的临床和影像学结果的研究中,我们对这些具有挑战性的动脉瘤显示了积极的结果,通过时间流量测定作为一种有价值的工具。提供动脉血流的定量测量,以帮助实现最佳的夹闭放置,最大限度地减少可能是再出血部位的动脉瘤残留。足够的流量,定义为 ≥ 基线的 50%,大大降低了不良结局的风险。

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