Derdeyn Colin P, Cross DeWitte T, Moran Christopher J, Brown George W, Pilgram Thomas K, Diringer Michael N, Grubb Robert L, Rich Keith M, Chicoine Michael R, Dacey Ralph G
Interventional Neuroradiology Service, Washington University School of Medicine, St Louis, MO, USA.
J Neurosurg. 2002 May;96(5):837-43. doi: 10.3171/jns.2002.96.5.0837.
Ischemic stroke or transient ischemic attack (TIA) may occur after the treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs). The purpose of the present study is to investigate possible risk factors for thromboembolic events and to determine their frequency and time course.
The records of 178 consecutive patients with 193 treated intracranial saccular aneurysms were reviewed. A total of 159 GDC procedures were performed to treat 143 aneurysms in 133 of those patients who were in good neurological condition, allowing clinical detection of postprocedure ischemic events (TIA or stroke). The association of clinical, anatomical, and pharmacological factors with intraprocedure intraarterial thrombus and with postprocedure ischemic events was investigated by using uni- and multivariate analyses. Thrombus protruding into the parent artery was noted during six of 159 GDC procedures, resulting in a clinical deficit in one patient. No factor was associated with intraprocedure intraarterial thrombus. Ten postprocedure ischemic events occurred in nine patients. Seven events occurred within 24 hours, and three events occurred between 24 hours and 58 days. Aneurysm diameter and protruding coils were significant independent predictors of postprocedure ischemic events in multivariate analysis (both p = 0.02). The actuarial risk of stroke was 3.8%.
Larger aneurysm diameter and protruding loops of coils are associated with postprocedure ischemic events after GDC placement. It is unlikely that GDC-treated aneurysms retain thromboembolic potential beyond 2 months.
使用 Guglielmi 可脱性弹簧圈（GDC）治疗颅内动脉瘤后可能发生缺血性卒中或短暂性脑缺血发作（TIA）。本研究的目的是调查血栓栓塞事件的可能危险因素，并确定其发生频率和时间进程。
回顾了 178 例连续患者 193 个已治疗的颅内囊状动脉瘤的记录。对其中 133 例神经功能良好的患者的 143 个动脉瘤进行了总共 159 次 GDC 手术，以便临床检测术后缺血事件（TIA 或卒中）。通过单因素和多因素分析研究临床、解剖和药理学因素与术中动脉内血栓以及术后缺血事件的相关性。在 159 次 GDC 手术中的 6 次手术中发现血栓突入载瘤动脉，导致 1 例患者出现临床功能缺损。没有因素与术中动脉内血栓相关。9 例患者发生了 10 次术后缺血事件。7 次事件发生在 24 小时内，3 次事件发生在 24 小时至 58 天之间。在多因素分析中，动脉瘤直径和突出的弹簧圈是术后缺血事件的显著独立预测因素（均 p = 0.02）。卒中的精算风险为 3.8%。
较大的动脉瘤直径和突出的弹簧圈圈与 GDC 置入术后的缺血事件相关。GDC 治疗的动脉瘤在 2 个月后不太可能保留血栓栓塞潜能。
