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タイトル: | Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3 |
著者: | NISHI, Hidehisa ISHII, Akira https://orcid.org/0000-0003-4234-2749 (unconfirmed) SATOW, Tetsu IIHARA, Koji SAKAI, Nobuyuki Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators |
著者名の別形: | 西, 秀久 石井, 暁 |
キーワード: | parent artery occlusion unruptured cerebral aneurysm Japanese Registry of Neuroendovascular Therapy |
発行日: | Jan-2019 |
出版者: | Japan Neurosurgical Society |
誌名: | Neurologia medico-chirurgica |
巻: | 59 |
号: | 1 |
開始ページ: | 1 |
終了ページ: | 9 |
抄録: | Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95% confidence interval (CI); 1.02–5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95% CI; 1.07–221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies. |
著作権等: | Copyright © 2019 by The Japan Neurosurgical Society. This work is licensed under a Creative Commons AttributionNonCommercial-NoDerivatives International License. |
URI: | http://hdl.handle.net/2433/236105 |
DOI(出版社版): | 10.2176/nmc.st.2018-0190 |
PubMed ID: | 30531152 |
出現コレクション: | 学術雑誌掲載論文等 |
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