Briganti F, Cirillo S, Caranci F, Esposito F, Maiuri F
Department of Neurological Sciences, Services of Neuroradiology, Federico II University, via S. Pansini 5, 80131 Naples, Italy.
Neuroradiology. 2002 Jul;44(7):604-9. doi: 10.1007/s00234-001-0732-4. Epub 2002 Jun 13.
Two personal cases of "de novo" aneurysms of the anterior communicating artery (ACoA) occurring 9 and 4 years, respectively, after endovascular carotid occlusion are described. A review of the 30 reported cases (including our own two) of "de novo" aneurysms after occlusion of the major cerebral vessels has shown some features, including a rather long time interval after the endovascular procedure of up to 20-25 years (average 9.6 years), a preferential ACoA (36.3%) and internal carotid artery-posterior communicating artery (ICA-PCoA) (33.3%) location of the "de novo" aneurysms, and a 10% rate of multiple aneurysms. These data are compared with those of the group of reported spontaneous "de novo" aneurysms after SAH or previous aneurysm clipping. We agree that the frequency of "de novo" aneurysms after major-vessel occlusion (two among ten procedures in our series, or 20%) is higher than commonly reported (0 to 11%). For this reason, we suggest that patients who have been submitted to endovascular major-vessel occlusion be followed up for up to 20-25 years after the procedure, using non-invasive imaging studies such as MR angiography and high-resolution CT angiography. On the other hand, periodic digital angiography has a questionable risk-benefit ratio; it may be used when a "de novo" aneurysm is detected or suspected on non-invasive studies. The progressive enlargement of the ACoA after carotid occlusion, as described in our case 1, must be considered a radiological finding of risk for "de novo" aneurysm formation.
本文描述了两例分别在血管内颈动脉闭塞术后9年和4年出现的前交通动脉（ACoA）“新生”动脉瘤的个人病例。对30例（包括我们自己的两例）报道的大脑主要血管闭塞后“新生”动脉瘤病例进行回顾后发现了一些特征，包括血管内手术后相当长的时间间隔，长达20 - 25年（平均9.6年），“新生”动脉瘤优先发生于ACoA（36.3%）和颈内动脉-后交通动脉（ICA - PCoA）（33.3%），以及10%的多发动脉瘤发生率。将这些数据与报道的蛛网膜下腔出血（SAH）或既往动脉瘤夹闭术后自发“新生”动脉瘤组的数据进行了比较。我们认同主要血管闭塞后“新生”动脉瘤的发生率（我们系列中的十例手术中有两例，即20%）高于通常报道的发生率（0至11%）。因此，我们建议对接受血管内主要血管闭塞术的患者在术后进行长达20 - 25年的随访，采用磁共振血管造影（MR angiography）和高分辨率CT血管造影等无创影像学检查。另一方面，定期数字血管造影的风险效益比存在疑问；当在无创检查中检测到或怀疑有“新生”动脉瘤时可使用。如我们病例1中所描述的颈动脉闭塞后ACoA的逐渐增大，必须被视为“新生”动脉瘤形成风险的影像学表现。
