Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients-Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

被引：27

作者：

Pierot, Laurent ^{[1
]}

Barbe, Coralie ^{[2
]}

Herbreteau, Denis ^{[3
]}

Gauvrit, Jean-Yves ^{[4
]}

Januel, Anne-Christine ^{[5
]}

Bala, Fouzi ^{[6
]}

Ricolfi, Frederic ^{[7
]}

Desal, Hubert ^{[8
]}

Velasco, Stephane ^{[9
]}

Aggour, Mohamed ^{[10
]}

Chabert, Emmanuel ^{[11
]}

Sedat, Jacques ^{[12
]}

Trystram, Denis ^{[13
]}

Marnat, Gaultier ^{[14
]}

Gallas, Sophie ^{[15
]}

Rodesch, Georges ^{[16
]}

Clarencon, Frederic ^{[17
]}

Papagiannaki, Chrysanthi ^{[18
]}

White, Phil ^{[19
,20
]}

Spelle, Laurent ^{[21
]}

机构：

[1] CHU Reims, Radiol, Reims, Champagne Arden, France

[2] CHU Reims, Dept Res & Publ Hlth, Reims, Champagne Arden, France

[3] CHRU Tours, Neuroradiol, Tours, Centre, France

[4] CHU Rennes, Neuroradiol, Rennes, Bretagne, France

[5] CHU Toulouse, Neuroradiol, Toulouse, Midipyrenees, France

[6] CHRU Lille, Pole Specialites Med Chirurg, Intervent Neuroradiol, Lille, Hauts De France, France

[7] CHU Dijon, Neuroradiol, Dijon, Bourgogne, France

[8] CHU Nantes, Neuroradiol, Nantes, Pays De La Loir, France

[9] CHU Poitiers, Radiol, Poitiers, France

[10] CHU St Etienne, Neuroradiol, St Etienne, Rhone Alpes, France

[11] CHU Clermont Ferrand, Neuroradiol, Clermont Ferrand, France

[12] CHU Nice, Neurointervent, Nice, Provence Alpes, France

[13] CH St Anne, Neuroradiol, Paris, Ile De France, France

[14] CHU Bordeaux, Intervent & Diagnost Neuroradiol, Bordeaux, Aquitaine, France

[15] CHU Bicetre, Neuroradiol, Le Kremlin Bicetre, Ile De France, France

[16] Hop Foch, Neuroradiol, Suresnes, Ile De France, France

[17] CHU Pitie Salpetriere, IFR 70, IFR Neurosci, Neuroradiol, Paris, Ile De France, France

[18] CHU Rouen, Intervent Neuroradiol, Rouen, Normandie, France

[19] Newcastle Univ, Inst Ageing & Hlth, Newcastle Upon Tyne, Tyne & Wear, England

[20] Newcastle Tyne Hosp, Neuroradiol, Newcastle Upon Tyne, Tyne & Wear, England

[21] CHU Bicetre, Intervent Neuroradiol, Le Kremlin Bicetre, Ile De France, France

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2020年 / 12卷 / 12期

关键词：

aneurysm; coil; hemorrhage; neck; RUPTURED CEREBRAL ANEURYSMS; TRIAL; EMBOLIZATION; RERUPTURE;

D O I：

10.1136/neurintsurg-2020-015971

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background Endovascular treatment is the first line therapy for the management of ruptured and unruptured intracranial aneurysms, but delayed aneurysm rupture leading to bleeding/rebleeding can occur subsequently. ARETA (Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm) is a prospective, multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed bleeding and rebleeding in this large cohort. Methods 16 neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015 (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics and endovascular techniques were recorded. Data were analyzed from participants with ruptured or unruptured aneurysms treated by coiling or balloon-assisted coiling. Rates of bleeding and rebleeding were analyzed and associated factors were studied using univariable and multivariable analyses. Results The bleeding rate was 0.0% in patients with unruptured aneurysms and 1.0% (95% CI 0.3% to 1.7%) in patients with ruptured aneurysms. In multivariate analysis, two factors were associated with rebleeding occurrence: incomplete aneurysm occlusion after initial treatment (2.0% in incomplete aneurysm occlusion vs 0.2% in complete aneurysm occlusion, OR 10.2, 95% CI 1.2 to 83.3; p=0.03) and dome-to-neck ratio (1.5 +/- 0.5 with rebleeding vs 2.2 +/- 0.9 without rebleeding, OR 0.2, 95% CI 0.04 to 0.8; p=0.03). Modalities of management of aneurysm rebleeding as well as clinical outcomes are described. Conclusions Aneurysm coiling affords good protection against bleeding (for unruptured aneurysms) and rebleeding (for ruptured aneurysms) at 1 year with rates of 0.0% and 1.0%, respectively. Aneurysm occlusion and dome-to-neck ratio are the two factors that appear to play a role in the occurrence of rebleeding.

引用

页码：1219 / 1225

页数：7

共 21 条

[1] Analysis of recanalization after endovascular treatment of intracranial aneurysm (ARETA trial): Presentation of a prospective multicenter study [J].