Endosaccular coiling is recognized as a feasible method for treating unruptured intracranial aneurysms (UIAs). We retrospectively reviewed cases of UIAs treated by coiling in the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3, a nationwide survey of NET between 2010 and 2014, the beginning period of intracranial stents in Japan. Data were extracted for 6844 UIAs (6619 procedures) from 40,169 registered records of all NETs in the JR-NET 3 databases. The features of the aneurysms and procedures, immediate radiographic findings, procedure-related complications, and clinical outcomes at 30 days after the procedures were assessed. Of 6844 UIAs, 81.8% were located in the anterior circulation. The mean patient age was 61.3 years (72.4% females). Compared with the preceding JR-NET 1 and 2, there were significant increases (P <0.05) in the rates of the following in JR-NET 3: wide-necked and small UIAs measuring <10 mm (from 56.4% to 58.8%), adjunctive techniques (54.8% to 71.8%), and stent usage (1.1% to 22.1%). Both pre- (85.6% to 96.7%) and post-procedural (84.0% to 94.6%) antiplatelet therapy were more frequently administered in JR-NET 3. Although procedure-related complication rates did not differ between the two groups, ischemic complication rates increased from 4.6% to 5.9%, leading to an increase in the 30-day morbidity (modified Rankin Scale >2) from 2.1% to 2.8%. In conclusion, introduction of neck-bridge stent was associated with an increase in cases of wide-necked aneurysms. However, the ischemic complication rate increased despite the greater use of periprocedural antiplatelet therapy.

译文

:囊状内盘绕术被认为是治疗未破裂颅内动脉瘤(UIA)的可行方法。我们回顾性研究了日本神经内膜血管治疗注册中心(JR-NET)3中盘绕治疗的UIA病例,JR-NET是2010年至2014年(日本颅内支架起始时期)的全国性NET调查。从JR-NET 3数据库中所有NET的40,169个注册记录中提取了6844个UIA(6619个过程)的数据。评估术后30天的动脉瘤和手术的特征,即时影像学发现,与手术相关的并发症以及临床结局。在6844个UIA中,有81.8%位于前循环中。患者平均年龄为61.3岁(女性为72.4%)。与先前的JR-NET 1和2相比,JR-NET 3中的下列比率显着增加(P <0.05):颈宽小于10 mm的小UIA(从56.4%增至58.8%) ,辅助技术(54.8%至71.8%)和支架使用率(1.1%至22.1%)。在JR-NET 3中,抗血小板治疗前(85.6%至96.7%)和术后(84.0%至94.6%)抗血小板治疗均更频繁。尽管两组的手术相关并发症发生率无差异,但缺血性并发症发生率从4.6%增加到5.9%,导致30天发病率(Rankin量表修正为> 2)从2.1%增加到2.8%。总之,颈桥支架的引入与宽颈动脉瘤病例的增加有关。然而,尽管更多地使用了围手术期抗血小板治疗,但缺血性并发症的发生率却有所增加。

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