Levy E, Koebbe C J, Horowitz M B, Jungreis C A, Pride G L, Dutton K, Kassam A, Purdy P D
Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
Neurosurgery. 2001 Oct;49(4):807-11; discussion 811-3. doi: 10.1097/00006123-200110000-00005.
In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed.
A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge.
Of 274 patients with intracranial aneurysms treated with coil embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52-85 yr). Mean follow-up time was 8 months (range, 0-25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, and 5 in two patients.
The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.
本研究回顾了颅内动脉瘤弹簧圈栓塞术中医源性动脉瘤破裂患者的发生率、病因及临床结局的处理情况。
对1994年至2000年6年间接受 Guglielmi 可脱性弹簧圈治疗的274例颅内动脉瘤患者进行回顾性分析。查阅患者病历以获取人口统计学数据、动脉瘤位置、动脉瘤破裂前后置入的弹簧圈数量、破裂病因以及入院时和出院时的临床状况。
在274例接受弹簧圈栓塞治疗的颅内动脉瘤患者中，有6例（2%）发生术中破裂。这6例中，2例为女性，4例为男性。平均年龄为67岁（范围52 - 85岁）。平均随访时间为8个月（范围0 - 25个月）。3例患者的动脉瘤破裂是由于最后一枚弹簧圈脱离，1例患者是由于（四枚中的）第三枚弹簧圈脱离，另1例患者是由于第一枚弹簧圈置入。1例患者的动脉瘤破裂是由于在最后一枚弹簧圈脱离前导管推进所致。末次随访检查时格拉斯哥预后评分，2例患者为1分，2例患者为2分，2例患者为5分。
弹簧圈栓塞术中动脉瘤破裂率约为2%至4%。临床结局可能与破裂时间及破裂前置入的弹簧圈数量有关。如果出现提示术中破裂的造影剂外渗情况，若安全可行，应尝试进一步置入弹簧圈。
