用 Guglielmi 可脱性弹簧圈治疗脑动脉瘤的血管造影随访：162 例 173 个动脉瘤的分析
Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils: an analysis of 162 cases with 173 aneurysms.
作者信息
Li M-H, Gao B-L, Fang C, Gu B-X, Cheng Y-S, Wang W, Scotti G
机构信息
Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
出版信息
AJNR Am J Neuroradiol. 2006 May;27(5):1107-12.
BACKGROUND AND PURPOSE
The endovascular approach, with the use of Guglielmi detachable coils (GDC), has been increasingly used to treat ruptured and unruptured cerebral aneurysms in recent years. Our objective was to assess the mid- to long-term radiologic outcome of cerebral aneurysms treated with GDC embolization.
METHODS
One hundred and sixty-two patients with a total of 173 aneurysms embolized with GDCs underwent angiographic follow-up 1 to 54 months after the procedure and were reviewed retrospectively. Each angiogram was reviewed by 2 neuroradiologists and 1 neurosurgeon, each of whom made a comparison between the initial and follow-up angiograms. Morphologic outcomes were scored as follows: unchanged, progressive thrombosis, and reopening or regrowth.
RESULTS
Of the 173 aneurysms with GDC embolization, 142 had total or nearly total occlusion, 23 subtotal occlusion, and 8 partial occlusion on the initial angiograms. The incidence of reopening was 17.1% (13/76) in less than 3 months and 6.2% (6/97) between 3 and 6 months after the procedure. Four aneurysms (2.3%) were found to be recurrent in the second follow-up angiography within 1 year after the procedure. The 1-year cumulative recurrent rate was 13.3%. Among 56 aneurysms with a third follow-up angiography in the period of 12 to 54 months after the procedure, 4 (7.1%) displayed a slight enlargement; the long-term cumulative recurrent rate was 20.4%.
CONCLUSION
The direct and primary causes for aneurysmal recurrence are incomplete and loose packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier for incompletely occluded aneurysms and at 6 months for totally or nearly totally occluded aneurysms. In case of total or nearly total occlusion that remains stable at follow-up, the interval for monitoring should be prolonged appropriately. Retreatment with balloon- or stent-assisted coil embolization is recommended for reopened aneurysms.
背景与目的
近年来，采用 Guglielmi 可脱卸弹簧圈（GDC）的血管内介入方法越来越多地用于治疗破裂和未破裂的脑动脉瘤。我们的目的是评估采用 GDC 栓塞治疗的脑动脉瘤的中长期影像学结果。
方法
162 例共 173 个动脉瘤接受 GDC 栓塞治疗的患者在术后 1 至 54 个月接受了血管造影随访，并进行回顾性分析。每位神经放射科医生和 1 名神经外科医生对每张血管造影进行评估，他们分别对初始血管造影和随访血管造影进行比较。形态学结果评分如下：无变化、血栓进展、再通或复发。
结果
在 173 个接受 GDC 栓塞的动脉瘤中，初始血管造影显示 142 个完全或几乎完全闭塞，23 个次全闭塞，8 个部分闭塞。术后 3 个月内再通发生率为 17.1%（13/76），术后 3 至 6 个月为 6.2%（6/97）。在术后 1 年内的第二次随访血管造影中发现 4 个动脉瘤（2.3%）复发。1 年累积复发率为 13.3%。在术后 12 至 54 个月期间进行第三次随访血管造影的 56 个动脉瘤中，4 个（7.1%）有轻度增大；长期累积复发率为 20.4%。
结论
动脉瘤复发的直接和主要原因是填塞不完全和不紧密。对于未完全闭塞的动脉瘤，建议在 3 个月或更早进行首次血管造影随访，对于完全或几乎完全闭塞的动脉瘤，建议在 6 个月进行随访。如果随访时完全或几乎完全闭塞保持稳定，应适当延长监测间隔。对于再通的动脉瘤，建议采用球囊或支架辅助弹簧圈栓塞进行再次治疗。
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