Piotin Michel, Spelle Laurent, Mounayer Charbel, Salles-Rezende Marco T, Giansante-Abud Daniel, Vanzin-Santos Ricardo, Moret Jacques
Department of Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, 25-29 rue Manin, 75940 Paris, Cedex 19, France.
Radiology. 2007 May;243(2):500-8. doi: 10.1148/radiol.2431060006. Epub 2007 Feb 9.
To retrospectively assess, with three-dimensional rotational angiography, the relationship between packing, complex coils, and angiographic recurrence of aneurysms treated with coils.
Informed consent was waived by the institutional review board that approved the study. Results at follow-up angiography of 255 aneurysms in 223 patients (161 female and 62 male patients; mean age, 48 years) were dichotomized into presence or absence of recurrence. The degree of packing of aneurysms treated with complex coils alone, with complex and helical coils, and with helical coils only was compared for significant differences. With generalized estimating equations analysis, relative risk (RR) for recurrence was calculated for mode of manifestation, duration of follow-up, aneurysm volume, packing, initial angiographic result, percentage of complex coils, aneurysm location, and multiplicity of aneurysms.
Follow-up angiography revealed recurrence in 28.6% of aneurysms at a mean follow-up of 12 months; 5.5% were amenable to re-treatment. Aneurysms treated with complex and those treated with helical coils only had a mean packing of 27% and 26%, respectively. There was no significant difference between packing of aneurysms treated with complex and those treated with helical coils (P = .538). Recurring and stable aneurysms both had a mean packing of 27%. Generalized estimating equations analysis showed significant differences between duration of follow-up and recurrence (P = .001, RR = 3.39), between aneurysm volume and recurrence (P < .001, RR = 6.15), and between hemorrhagic manifestation and recurrence (P = .002, RR = 3.17). There was no significant difference between packing and recurrence, between initial angiographic result and recurrence, between percentage of complex coils and recurrence, between aneurysm location and recurrence, or between multiplicity of aneurysms and recurrence.
More angiographic recurrences are detected over time. Complex coils do not augment aneurysm packing. Packing is not related to protection against recurrence.
采用三维旋转血管造影术，回顾性评估动脉瘤弹簧圈栓塞治疗中填塞情况、复杂弹簧圈与动脉瘤血管造影复发之间的关系。
本研究获机构审查委员会批准，该委员会免去了知情同意程序。223例患者（161例女性，62例男性；平均年龄48岁）的255个动脉瘤随访血管造影结果分为复发和未复发。比较单纯使用复杂弹簧圈、联合使用复杂弹簧圈和螺旋弹簧圈以及仅使用螺旋弹簧圈治疗的动脉瘤的填塞程度，分析其差异是否具有统计学意义。采用广义估计方程分析，计算复发的相对风险（RR），分析指标包括表现形式、随访时间、动脉瘤体积、填塞情况、初始血管造影结果、复杂弹簧圈百分比、动脉瘤位置以及动脉瘤的多发性。
随访血管造影显示，平均随访12个月时，28.6%的动脉瘤复发；5.5%的复发动脉瘤适合再次治疗。单纯使用复杂弹簧圈和仅使用螺旋弹簧圈治疗的动脉瘤平均填塞率分别为27%和26%。使用复杂弹簧圈和螺旋弹簧圈治疗的动脉瘤填塞率之间无显著差异（P = 0.538）。复发和稳定的动脉瘤平均填塞率均为27%。广义估计方程分析显示，随访时间与复发之间存在显著差异（P = 0.001，RR = 3.39），动脉瘤体积与复发之间存在显著差异（P < 0.001，RR = 6.15），出血表现与复发之间存在显著差异（P = 0.002，RR = 3.17）。填塞情况与复发之间、初始血管造影结果与复发之间、复杂弹簧圈百分比与复发之间、动脉瘤位置与复发之间以及动脉瘤多发性与复发之间均无显著差异。
随着时间推移，血管造影复发的动脉瘤增多。复杂弹簧圈不会增加动脉瘤的填塞率。填塞情况与预防复发无关。
