文献回顾未破裂动脉瘤课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,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.,Pierot, L., L. Spelle, and F.,1,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 months,ATENA: Analysis of Treatment b,2,Patients and aneurysm criterea,aneurysms less than 15 mm.,Excluded aneurysms:,Fusiform and dissecting aneurysms,aneurysms associated with brain arteriovenous malformations,In case of recent subarachnoid hemorrhage (1 month) related to another aneurysm,Patients and aneurysm criterea,3,Clinical outcomes evaluation,Clinical status: mRS,Permanent morbidity and mortality of the treatment was evaluated at 1 month:,Morbidity:,Asymptomatic aneurysms: mRS 25;,Symptomatic aneurysms: mRS previous,mortality:,Any death within 30 days of endovascular treatment,Anatomical results:,modified 3-point Jean Raymond classification scale:,complete occlusion, neck remnant, and aneurysm remnant,Clinical outcomes evaluationCl,4,Description of patients population and aneurysms,24 patients/center,649 patients: 468 female patients, 181 male patients,649 patients with 1100 UIAs, 289 patients with multiple UIAs,700 procedures were performed to treat 739 aneurysms,Anterior circulation: 91.9%,Posterior circulation: 8.1%,Description of patients popula,5,results,Parent artery occlusion: 12,Coils: 727 aneurysms,396 aneurysms: coils alone,271 aneurysms: remodeling techqiues,Stenting: 57,Trispan: 3,resultsParent artery occlusion,6,Feasibility 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 unsafe,8 aneurysms: due to technique problems: difficulties in microcather placement,14 MCA UIAs failed,Size: failure rate: 16mm 5.7% 715mm: 2.3% p=0.022,Dome-to-neck ratio: 1.5 3.1%. P=0.57,Feasibility of Endovascular Tr,7,104 adverse events:,88 sepecific adverse events,50 ischemic stroke,18 anerysms ruptured,20 coil related events,16 puncture related events,104 adverse events:,8,Factors affecting the procedure-related problems,No,significant,significant,No,Factors affecting the procedur,9,文献回顾未破裂动脉瘤课件,10,文献回顾未破裂动脉瘤课件,11,11 patients: (1.7%),6: ischemic stroke,4: aneurysm rupture,1: UIAs unrelated hemotoma,9 death (1.4%),6: died during or immediately after treatment,1: anesthetic complication,2: several days after the treatment: intracranial hemotoma,11 patients: (1.7%),12,Factors 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%;,P,0.008),Factors Affecting Complication,13,Comparison between sugery and EVT,No direct comparison in a randomized study available,single-center series,Johnston(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 coiling,Higashida(2007): endovascular treatment was associated with fewer adverse outcomes (6.6% versus 13.2%), decreased mortality (0.9% versus 2.5%),Comparison between sugery and,14,limitations,inclusion bias,cognitive status of the patients was not evaluated,limitationsinclusion bias,15,Pierot, 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.,Pierot, L., L. Spelle, and F.,16,