surpass flow diverter for treatment of posterior circulation aneurysms c.a. taschner资料.pdf

该【surpass flow diverter for treatment of posterior circulation aneurysms c.a. taschner资料 】是由【李十儿】上传分享，文档一共【8】页，该文档可以免费在线阅读，需要了解更多关于【surpass flow diverter for treatment of posterior circulation aneurysms c.a. taschner资料 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。PublishedDecember22,.,,,,,,,,,,,,,,:?:Weconductedanobservationalstudyof53patientswhounderwent?ow-,andmodi?edRankinScalescoreatfollow-:Atfollow-up(median,;interquartilerange,–),9patientshaddied,resultinginanall-%(95%CI,7%–%);7deaths(14%),abaselinemRSof3–5wasmoresigni?cantly(P?.003)associatedwithahigherhazardratiofordeaththanabaselinemRSof0–2(hazardratio,;95%CI,–).Afteradjustingforfollow-upduration,a1-pointincreaseinthebaselinemRSwassigni?cantly(P?.001)associatedwithhighervaluesofmRSatfollow-up(oddsratio,;95%CI,–).Follow-upangiographyin44patients(median,;interquartilerange,–)lusionin29(66%;95%CI,%–%).CONCLUSIONS:Clinicalresultsof?ow-,:BT?basilartrunk;FD??owdiverter;HR?hazardratio;KWANOVA?Kruskal-Wallisanalysisofvariance;PCA?posteriorcerebralartery;Q1–Q3?quartiles1–3;VB?vertebrobasilarlowdiverters(FDs)-4Thelargeplexaneurysms,1buttheiruseforaneurysmsnumberofperforatingandbranchingarteriesoftheposteriorcirculationpotentiallyincreasestheriskinflowdiversion,expos-plicationsandbrainstemReceivedAugust3,2016;,fusiformaneurysmsoftheverte-FromtheDepartmentofNeuroradiology(.,.,.,.),MedicalCentre–brobasilar(VB)junctionorbasilartrunk(BT)hasbeenassociatedUniversityofFreiburg,Freiburg,Germany;DepartmentofRadiology(.),New2-4EnglandCenterforStrokeResearch(.),andDivisionofNeuroimagingandwithhighmorbidityandmortalityofupto71%.Intervention(.),DepartmentsofRadiology,Neurology,andNeurosurgery,Arecentmeta-analysisidentified14studies,whichreportedUniversityofMassachusettsMedicalSchool,Worcester,Massachusetts;Depart-mentofNeurosurgery(.,.),RadboudUniversityNijmegenMedicalCenter,on225posteriorcirculationaneurysmstreatedwithFDsin220Nijmegen,herlands;-eratewas79%Therapy(.),UniversityofBesanc?on,Besanc?on,France;DepartmentofNeurosur-gery(.),KobeCityMedicalCenterGeneralHospital,Kobe,Japan;Department(95%confidenceinterval,72%–84%),andtheprocedure-relatedofNeurosurgery(.),EquipodeNeurocirugíaEndovascularRadiologíaInterven-mortalityratewas15%(95%CI,10%–21%).Moststudiesin-cionista,BuenosAires,Argentina;NationalInstituteofNeurosciences(.),Buda-pest,Hungary;DepartmentofNeurosurgery(.),BaylorCollegeofMedicine,Chicago,Illinois;andtheAnnualMeetingoftheGermanSocietyofNeuroradiol-Houston,Texas;andDepartmentofNeuroradiology(.),KlinikumKassel,Kassel,ogy,October15–17,2015;Cologne,,MD,DepartmentofNeu-WeobtainedatravelgrantformonitoringvisitsfromStrykerNeurovascular($1100).roradiology;MedicalCenter–UniversityofFreiburg,Breisacherstr64,D-79106TrialRegistration:queidenti?er:,Germany;e-mail:christian.******@uniklinik-:Anatomy,Biology,esstonon-subscribersatCorrelations-WorkingGroupinInterventionalNeuroradiology(ABC-WIN)Semi-Indicatesarticlewithsupplementalon-,January18–23,2015;Vald’Ise`re,France;theAmericanSocietyofNeuroradiol-ogyAnnualMeetingandtheFoundtionoftheASNRSymposium,April25–30,2015;http://dx./●:●●(median,;range,locationwasdefinedasacategoricvariablerepresentingtheVB5–55),andmostofthesepatients(155/220)weretreatedwiththejunction,BT,V4,andposteriorcerebralartery(PCA).PipelineEmbolizationDevice(Covidien,Irvine,California).Dataweremissingforageandsexin1patient;aneurysmsize,TheSurpassFD(StrykerNeurovascular,Fremont,California)inanotherpatient;andneckdiameter,-diedbeforedischarge,and2diedafterdischarge(mRSscoresatteriorcirculation:1)Themaximumlengthof50mmallowsan-discharge:1and5)andbeforethefirstfollow--eurysmtreatmentwithasingledevice,thusavoidingtelescoping;ing48patients,angiographicfollow-)duetotherhomboidshapeoftheFDcells,theflow--,thisfeatureenablesconsistentporosityand(presentation),discharge,andfollow--,,plications,newneurologicdeficitsat24hoursparedwiththePipelineEmbolizationDevice,followingtheprocedure,mRSscoreathospitaldischarge,–5atclinicalfollow--suresinpatientstreatedwiththeSurpassFDforaneurysmslo-(bi-MATERIALSANDMETHODSnary),newneurologicdeficitat24hoursposttreatment(binary),StudyDesignandParticipantsmRSatdischarge(ordinal),lusionatlastThismulticenter,retrospective,observationalstudywasap-angiographicfollow-up(binary),mRSatlastclinicalfollow-up(or-mitteeoftheleadinstitutiondinal),mortality(binary),andmorbidity(binary)atlastfollow-up.(FacultyofMedicine,UniversityofFreiburg)andwasregisteredintheGermanClinicalTrialsRegister(DRKS-ID:DRKS00006881).lusion(binary)wasInEurope,patientsweretreatedwiththeSurpassFDafteritre-(CEMark);occurredandthedateofdeathwasknown,itwasspecifiedasthelast?outsideEurope,passionateusefollow--up,thedateofdeathcouldnottheyhadaposteriorcirculationaneurysmforwhichtreatmentbedetermined;hence,thedateoflastclinicalcontactwaspragmati-?(;SASInstitute,Cary,NorthCarolina).Forallfinalanalyses,accordancewithlocalinstitutionalguidelinesateachparticipat-effectsassociatedwithP?.05wereconsideredstatisticallysignif-,eachpatientwasgivendualanti-(Spearman?)betweenallvariableswereas-,thisconsistedofclopidogrel,75mg,,parisonsandaspirin,325mg,,-routinelygivenaloadingdoseofclopidogrel,600mg,andaspirin,tors(numberofFDs,additionalcoiling)andpatientcharacteris-325mg,-(,newdeficitsat24hoursposttreatment)wereana-e,andimagingfollow---eorvariablesthathadP?.2inunivariatelogisticCollecteddataincludedage,sex,modifiedRankinScalescoreatregressionwereincludedinthecorrespondingmultivariablelo-baseline,aneurysmlocation,aneurysmsize(height,width,-depth)andmorphology,neckdiameter(infusiformaneurysms,ablemodels,interactionamongpredictorswasevaluatedandisthelengthoftheaffectedvesselsegmentwasconsideredthean--Lemeshowgoodness-of-fiteurysmneck),previoustreatmentattempts,rupturestatus,num-,additionalcoiling,plications,es(mRSatdischarge,mRSatlastclinicalneurologicdeficits24hoursposttreatment,mRSscoreatdis-follow-up)wereinitiallymodeledbyusingorderedlogisticre-charge,mRSscoreatlastclinicalfollow-up,durationofclinicalgression,andiftheproportionaloddsassumptioncouldnotbefollow-up(months),lu-satisfied,generalizedlinearmodelswerefitbyspecifyingamulti-sionbyusingKamranorRaymondscores,timepointofangio-nomialdistributionandcumulativelogit--up,anddateofdeath(ifapplicable).emeasurewere2Taschner●2017includedintheinitialmodel,whichwasrefinedbysequentiallyTable1:PatientdataandcharacteristicsofaneurysmstreatedexcludingthevariablewiththehighestPvalue,providedthatthewithFDPvaluewas?.-of-fitofthemodelwasassessedCharacteristicsPatients(No.)52byusingthePearson?(No.)52Kaplan-MeiersurvivalanalysisandtheCoxproportionalhaz-Women(%)21/52(41%)pleteMeanage(range)(yr)54(16–79)occlusion,mortality,andmorbidity)assessedatvaryingtimePresentation/indicationsfortreatment(No.)(%),survivalanalysiswasper-Incidental?nding/headaches20(38%)-Recurrentaftercoiling/coilingand16(31%)riatesthatexhibitedP?.1inKaplan-Meieranalysiswerein-stenting/failedclippingcludedintheCoxproportionalhazardsmodelthatusedstepwiseCranialnervede?cit/masseffect14(27%)Stroke/transientischemicattack7(13%),cumulativeMar-AcuteSAH7(13%)tingaleresidualstocheckthefunctionalformforthecontinuousBaselinemRS(No.)variablesandastandardizedscoreprocesstocheckthepropor-mRS020(38%)-typemRS1–218(35%)mRS3–514(27%)(n?51)(%)?5mm4(8%)5–(25%)RESULTS10–20mm17(33%)FromJuly2010throughMarch2015,datafrom53consecutive?20mm17(33%)patientswith53acutelyrupturedorunrupturedaneurysmsintheAneurysmnecksize(mm)?posteriorcirculationtreatedwithSurpassFDsat15centersin8Mean(range)(2–90)Location(No.)(%)(38%)ularvertebralarteryaneurysm,tortuosityofmajorvesselsVBjunction11(21%),BT15(29%)andtheaneurysmwastreatedwithstent-(12%)Morphology(No.)(%)patientwasexcludedfromthiscohortanalysis,resultinginafinalWide-ular12(23%)(77%)??(range,1–3)(29%)Patientdemographics,clinicalpresentations,andaneurysmchar-,20(38%)weremRS0,18(35%)weremRS1or2,and14(27%)weremRSclarity,emeasuresarelistedinthetempo-3–,(77%)(33%)were?--Figures1and2showcaseexamples,andFig3summarizestheteredin9(17%)of52patients(95%CI,%–%).-problemswerethefollowing:breakageofthepusherwireoftheticalanalysisareavailableinOn-ables1–