| Objective:To evaluate the safety and efficacy of endovascular interventional treatment of the intracranial vertebrobasilar trunk large aneurysm.Methods:This is a prospective multi-center cohort study.From October 2012 to October 2018,a total of 69 patients with intracranial vertebrobasilar trunk large aneurysm(diameter>10mm)were included in this study.51 patients who underwent endovascular reconstructive,deconstructive or conjunction interventional treatments were enrolled in interventional group,and 18 patients who received antiplatelet or risk factors control were enrolled in conservative group.Meanwhile,430 intracranial vertebrobasilar trunk large aneurysm cases published were retrieved from the Chinese Wanfang database and the National Biotechnology Information Center database.The primary outcomes were the incidence of serious adverse events related to the protocol in the interventional group and the conservative group.Secondary outcomes included mortality,hemorrhagic stroke,ischemic stroke and non-stroke related serious adverse events in the interventional group and the conservative group,and aneurysm occlusion rate in the interventional group.Results:The incidence of all serious adverse events associated with protocol was 15.7%in the interventional group and 44.4%in the conservative group(RR=0.353;95%CI,0.156-0.801).The incidence of fatal events associated with protocol was 2.0%in the interventional group and 38.9%in the conservative group(RR=0.050;95%CI,0.007-0.387).The incidence of hemorrhage events associated with protocol was 2.0%in the interventional group and 22.2%in the conservative group(RR=0.088;95%CI,0.011-0.738).Follow-up imaging showed that the occlusion rate of aneurysms in 44 patients in the interventional group was 56.8%(25/44).Survival analysis showed that death-free cumulative survival rates of the the interventional group and conservative group within 1 year,3 years and 5 years were 98.0%vs 83.3%(P=0.020),98.0%vs 61.5%(P=0.002)and 98.0%vs 32.8%(P<0.001)respectively,and the cumulative survival rate of the serious adverse events free and stroke free within 5 years were 85.5%vs 32.8%(P=0.007),and 85.5%vs 32.8%(P=0.020)respectively.The results of subgroup analysis showed that the cure rate of deconstruction(100%,10/10)was higher than that of reconstruction(40.6,13/32)(P<0.001),and the cure rate of stenting combined coiling(54.2%,13/24)in the reconstruction group was higher(P=0.040).Regression analysis showed that the risk of serious adverse events of the interventional treatment was 0.344 times(95%CI,0.119 0.995)of the conservative treatment,the risk of strokes of the group with ischemic onset was 4.447 times(95%CI,1.444 13.700)of the other reasons onset,the risk of death in the interventional treatment was 0.04 times(95%CI,0.004 0.373)of the conservative treatment,and the risk of death in the large aneurysm group was 0.126 times(95%CI,0.021 to 0.772)of giant aneurysm group;The comparison between the results of the two groups of our research data and the results of literature analysis showed that the mortality rate(2.0%)of the interventional group in our research was lower than that in literature analysis(13.0%)(P=0.030).Conclusion:Compared with conservative treatment,endovascular intervention of the intracranial vertebrobasilar trunk large aneurysm has lower incidences of serious adverse events,death events and hemorrhagic stroke events.It can effectively prevent the occurrence of long-term serious adverse events and stroke events in the intracranial vertebrobasilar trunk large aneurysm patients,as well as the occurrence of short-term and long-term death events.Deconstructive intervention has a higher cure rate of occlusion,and in the reconstructive intervention,conjunction of stenting and coiling has a higher cure rate of occlusion.The type of onset is a predictor of stroke events,the protocol of treatment is a predictor of severe adverse events,and the size of aneurysms and the protocol of treatment are predictors of death. |
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