Kwon O-Ki, Kim Seong Hyun, Kwon Bae Ju, Kang Hyun-Seung, Kim Jae Hyoung, Oh Chang Wan, Han Moon Hee
Department of Neurosurgery, Seoul National University College of Medicine, Korea.
AJNR Am J Neuroradiol. 2005 Apr;26(4):894-900.
The endovascular occlusion of aneurysms with unfavorable configurations such as a broad neck and an important branch from the fundus remains a technical challenge. The purpose of this study was to evaluate the radiologic and clinical results of complicated aneurysm treatment by using two microcatheters.
Twenty-five aneurysms in 25 patients were treated by using two microcatheters, from August 2001 to February 2004. Fourteen patients presented with a subarachnoid hemorrhage (SAH) and 11 had unruptured aneurysms. The aneurysms were of the basilar top (7), middle cerebral artery bifurcation (4), posterior communicating artery (4), anterior communicating artery (3), superior cerebellar artery (2), ophthalmic artery (2), and one aneurysm of each of cavernous internal carotid artery (ICA), dorsal ICA, and midbasilar artery. In 16 aneurysms (64%), the width of the aneurysm was the same or longer than the height. In 19 (76%), important branches arose from the aneurysm base, and some were even incorporated with the aneurysm fundus. The mean dome (height)-to-neck ratio was 1.23 +/- 0.37 (range, 0.65-2.33), and this was greater than or equal to 1.0 in 19 aneurysms (76%).
All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in eight aneurysms (32%), and some residual contrast filling in 16. The aneurysm remnants, however, were intentionally left to preserve important branches in 12 of the 16 aneurysms with incomplete occlusion. Two complications occurred, including one thromboembolic and one coil protrusion, but they were successfully resolved and produced no clinical symptoms. All patients except one showed excellent clinical outcomes. One patient revealed moderate cognitive dysfunction. During the follow-up period, no new bleeding occurred.
Our experience with 25 cerebral aneurysm patients shows that the technique of using two microcatheters is feasible and safe for coil embolization of aneurysms with unfavorable configurations. Although the lack of angiographic follow-up prevents us from drawing conclusions about its effectiveness as compared with other techniques such as stent placement and balloon-neck protection, we believe that this technique offers a reliable alternative for endovascular therapy of complicated aneurysms.
对具有如宽颈及从瘤底发出重要分支等不良形态的动脉瘤进行血管内栓塞仍然是一项技术挑战。本研究的目的是评估使用两根微导管治疗复杂动脉瘤的影像学和临床结果。
2001年8月至2004年2月期间，对25例患者的25个动脉瘤使用两根微导管进行治疗。14例患者表现为蛛网膜下腔出血（SAH），11例有未破裂动脉瘤。动脉瘤位于基底动脉顶端（7个）、大脑中动脉分叉处（4个）、后交通动脉（4个）、前交通动脉（3个）、小脑上动脉（2个）、眼动脉（2个），海绵窦段颈内动脉（ICA）、颈内动脉背侧和基底动脉中部各有1个动脉瘤。16个动脉瘤（64%）的宽度等于或大于高度。19个（76%）有重要分支从动脉瘤基底发出，有些甚至与动脉瘤瘤底融合。平均瘤顶（高度）与瘤颈比值为1.23±0.37（范围0.65 - 2.33），19个动脉瘤（76%）该比值大于或等于1.0。
所有动脉瘤均成功栓塞。栓塞后即刻血管造影显示，8个动脉瘤（32%）无造影剂残留充盈，16个有一些造影剂残留充盈。然而，在16个不完全闭塞的动脉瘤中，有12个为保留重要分支而故意留有待处理的动脉瘤残端。发生了2例并发症，包括1例血栓栓塞和1例弹簧圈突出，但均成功解决且未产生临床症状。除1例患者外，所有患者临床结果均为优良。1例患者出现中度认知功能障碍。随访期间无新发出血。
我们对25例脑动脉瘤患者的经验表明，使用两根微导管技术对形态不良的动脉瘤进行弹簧圈栓塞是可行且安全的。尽管缺乏血管造影随访，使我们无法与支架置入和球囊颈保护等其他技术比较其有效性，但我们认为该技术为复杂动脉瘤的血管内治疗提供了一种可靠的替代方法。
