Mordasini Pasquale, Schroth Gerhard, Guzman Raphael, Barth Alain, Seiler Rolf W, Remonda Luca
Department of Neuroradiology, University Hospital of Bern, Bern, Switzerland.
AJNR Am J Neuroradiol. 2005 Aug;26(7):1732-8.
The purpose of this study was to analyze the immediate and long-term angiographic and clinical results of endovascular treatment of posterior circulation aneurysms with special regard to technical development.
Between 1993 and 2003, 46 patients with 47 aneurysms of the posterior circulation were referred to our institution for endovascular treatment. Mean angiographic follow-up was 1.7 years. Clinical follow-up was determined at hospital discharge and by using a questionnaire for long-term follow-up (mean, 3.3 years). To analyze technical development, patients treated before (group 1) and after (group 2) implementation of 3D Guglielmi detachable coils (3D GDCs) in 1999 were compared. Multivariate analysis was performed to determine factors predictive of clinical and technical outcome.
Overall, at initial treatment complete occlusion was achieved in 27 (57.4%) aneurysms, a neck remnant was present in 16 (34.0%) aneurysms, incomplete occlusion was achieved in 3 (6.4%) aneurysms, and in 1 (2.1%) case occlusion was not attempted. Procedure-related permanent morbidity was 4.3%, and the mortality rate was 0%. There was no rebleeding of treated aneurysms. Complete occlusion at initial treatment (P = .003) and recanalization rate (P = .008) correlated with aneurysm sac size. A statistically significant relationship between Hunt and Hess/World Federation of Neurologic Surgeons clinical grading scale score and clinical outcome (Glasgow Outcome Score) was found (P < .05). Subgroup analysis revealed that a higher initial obliteration rate of larger aneurysms was achieved in group 2 (3D GDC, 22 patients, 22 aneurysms) than in group 1 (23 patients, 24 aneurysms; P = .03). At angiographic follow-up, overall recanalization was 47.1% in group 2 and 47.6% in group 1. Aneurysm neck size was not found to be correlated with occlusion and recanalization rate.
In our series, GDC technology was an effective and safe technique for the treatment of posterior circulation aneurysms. Aneurysm sac size was predictive for occlusion rate and the Hunt and Hess/World Federation of Neurologic Surgeons grade for clinical outcome. The introduction of 3D GDCs into our practice significantly improved the initial occlusion rate but did not affect the incidence of recanalization.
本研究旨在分析后循环动脉瘤血管内治疗的即刻及长期血管造影结果和临床结果，并特别关注技术发展情况。
1993年至2003年间，46例患有47个后循环动脉瘤的患者被转诊至我院接受血管内治疗。血管造影的平均随访时间为1.7年。临床随访在出院时确定，并通过问卷调查进行长期随访（平均3.3年）。为分析技术发展情况，比较了1999年3D Guglielmi可脱卸弹簧圈（3D GDC）应用之前（第1组）和之后（第2组）接受治疗的患者。进行多因素分析以确定预测临床和技术结果的因素。
总体而言，初始治疗时27个（57.4%）动脉瘤实现了完全闭塞，16个（34.0%）动脉瘤存在颈部残留，3个（6.4%）动脉瘤实现了不完全闭塞，1例（2.1%）未尝试闭塞。与手术相关的永久性致残率为4.3%，死亡率为0%。治疗的动脉瘤未发生再出血。初始治疗时的完全闭塞（P = .003）和再通率（P = .008）与动脉瘤囊大小相关。发现Hunt和Hess/世界神经外科医师联合会临床分级量表评分与临床结果（格拉斯哥预后评分）之间存在统计学显著关系（P < .05）。亚组分析显示，第2组（3D GDC，22例患者，22个动脉瘤）中较大动脉瘤的初始闭塞率高于第1组（23例患者，24个动脉瘤；P = .03）。在血管造影随访中，第2组的总体再通率为47.1%，第1组为47.6%。未发现动脉瘤颈部大小与闭塞及再通率相关。
在我们的系列研究中，GDC技术是治疗后循环动脉瘤的一种有效且安全的技术。动脉瘤囊大小可预测闭塞率，Hunt和Hess/世界神经外科医师联合会分级可预测临床结果。在我们的实践中引入3D GDC显著提高了初始闭塞率，但未影响再通发生率。
