1、Review of published papers,Hu Peng2010-7-20,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.,ATENA: Analysis of Treatment by Endovasc
2、ular approach of Non ruptured Aneurysms.Conducted by the French Society of Neuroradiology (SFNR)27 Canadian and French neurointerventional centers.17 months,Patients and aneurysm criterea,aneurysms less than 15 mm.Excluded aneurysms:Fusiform and dissecting aneurysmsaneurysms associated with brain ar
3、teriovenous malformationsIn case of recent subarachnoid hemorrhage (1 month) related to another aneurysm,Clinical outcomes evaluation,Clinical status: mRSPermanent morbidity and mortality of the treatment was evaluated at 1 month:Morbidity:Asymptomatic aneurysms: mRS 25;Symptomatic aneurysms: mRS pr
4、eviousmortality:Any death within 30 days of endovascular treatmentAnatomical results:modified 3-point Jean Raymond classification scale:complete occlusion, neck remnant, and aneurysm remnant,Description of patients population and aneurysms,24 patients/center649 patients: 468 female patients, 181 mal
5、e patients649 patients with 1100 UIAs, 289 patients with multiple UIAs700 procedures were performed to treat 739 aneurysmsAnterior circulation: 91.9%Posterior circulation: 8.1%,results,Parent artery occlusion: 12Coils: 727 aneurysms396 aneurysms: coils alone271 aneurysms: remodeling techqiuesStentin
6、g: 57Trispan: 3,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, vesse
7、l arising from the neck of the aneurysm, and small size of the aneurysm making deposition of coils difficult and unsafe8 aneurysms: due to technique problems: difficulties in microcather placement14 MCA UIAs failedSize: failure rate: 16mm 5.7% 715mm: 2.3% p=0.022Dome-to-neck ratio: 1.5 3.1%. P=0.57,
8、104 adverse events:88 sepecific adverse events50 ischemic stroke18 anerysms ruptured20 coil related events16 puncture related events,Factors affecting the procedure-related problems,No,significant,significant,No,11 patients: (1.7%)6: ischemic stroke4: aneurysm rupture1: UIAs unrelated hemotoma9 deat
9、h (1.4%)6: died during or immediately after treatment1: anesthetic complication2: several days after the treatment: intracranial hemotoma,Factors Affecting Complications of Endovascular Treatment of Unruptured Intracranial Aneurysms:Ischemic stroke: not significantly different according to the locat
10、ion 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%; P0.008),Comparison
11、 between sugery and EVT,No direct comparison in a randomized study availablesingle-center seriesJohnston(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 coilingHigashida(2007): endovascular treatment was associated with fewer adverse outcomes (6.6% versus 13.2%), decreased mortality (0.9% versus 2.5%),limitations,inclusion biascognitive status of the patients was not evaluated,
