Cloft Harry J, Kallmes David F
Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1706-9.
The risk of intraprocedural aneurysm perforation in patients with previously ruptured aneurysms tends to be higher than that of patients with previously unruptured aneurysms, but a statistically significant difference has not been shown. Our purpose was to define the rates of occurrence and of morbidity and mortality associated with aneurysmal perforation associated with coil embolization.
A meta-analysis of the results from 17 published retrospective reports of aneurysm perforations complicating therapy with Guglielmi detachable coils (GDCs) was performed. Rates of perforation and associated morbidity and mortality in previously ruptured and unruptured aneurysms were calculated. The mechanism of perforation was noted.
The risk of intraprocedural perforation was significantly higher in patients with ruptured aneurysms compared with patients with unruptured aneurysms (4.1% vs 0.5%; P <.001). The combined risk of permanent neurologic disability and death associated with intraprocedural aneurysm perforation was 38% for ruptured aneurysms and 29% for unruptured aneurysms. The morbidity and mortality rates with perforations caused by coils (39%) and microcatheters (33%) were similar. The morbidity and mortality rate for microguidewire perforations was considerably lower (0%, n = 4) than the rates for coils and microcatheters, but number of cases was too low to indicate statistical significance.
The risk of aneurysm perforation during GDC therapy is much higher in patients with previously ruptured aneurysms than in those with unruptured aneurysms. The morbidity and mortality rates are substantial for perforations caused by coils and microcatheters, whereas they seem to be much lower for perforations caused by microguidewires.
既往有动脉瘤破裂史的患者在手术过程中动脉瘤穿孔的风险往往高于既往未破裂动脉瘤患者，但尚未显示出统计学上的显著差异。我们的目的是确定与弹簧圈栓塞相关的动脉瘤穿孔的发生率以及发病率和死亡率。
对17篇已发表的关于使用 Guglielmi 可脱性弹簧圈（GDC）治疗动脉瘤并发穿孔的回顾性报告结果进行荟萃分析。计算既往破裂和未破裂动脉瘤的穿孔率以及相关的发病率和死亡率。记录穿孔机制。
与未破裂动脉瘤患者相比，破裂动脉瘤患者在手术过程中穿孔的风险显著更高（4.1% 对 0.5%；P <.001）。与手术过程中动脉瘤穿孔相关的永久性神经功能残疾和死亡的综合风险，破裂动脉瘤为38%，未破裂动脉瘤为29%。由弹簧圈（39%）和微导管（33%）引起的穿孔的发病率和死亡率相似。微导丝穿孔的发病率和死亡率（0%，n = 4）远低于弹簧圈和微导管引起的穿孔，但病例数太少，无法显示统计学意义。
在GDC治疗过程中，既往有动脉瘤破裂史的患者动脉瘤穿孔的风险远高于未破裂动脉瘤患者。由弹簧圈和微导管引起的穿孔的发病率和死亡率很高，而由微导丝引起的穿孔的发病率和死亡率似乎要低得多。
