de Gast Anjob N, Sprengers Marieke E, van Rooij Willem Jan, Lavini Cristina, Sluzewski Menno, Majoie Charles B
Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands.
Neurosurgery. 2007 Jun;60(6):1025-9; discussion 1029-31. doi: 10.1227/01.NEU.0000255468.30011.AA.
The purpose of this study was to evaluate aneurysm size and clinical symptoms midterm after therapeutic carotid artery occlusion in 39 patients with large or giant carotid artery aneurysms.
Between January 1996 and August 2004, 39 patients with large or giant carotid artery aneurysms were treated with therapeutic carotid artery occlusion and had clinical and magnetic resonance imaging follow-up of at least 3 months (mean, 35.9 mo; median, 29 mo; range, 3-107 mo; 117 patient-yr). Initial clinical presentation was mass effect caused by the aneurysm in 32 (82%) of the 39 patients. Three patients presented with subarachnoid hemorrhage and one presented with epistaxis; two aneurysms were an incidental finding and one was additional to another ruptured aneurysm.
There were no early or late complications of therapeutic carotid artery occlusion. All aneurysms seemed to have thrombosed completely after carotid artery occlusion as observed on early and late magnetic resonance imaging and magnetic resonance angiographic follow-up studies. At the time of the most recent magnetic resonance imaging follow-up study, 29 (74%) of the 39 aneurysms involuted totally, two aneurysms decreased to 25% of the original diameter, two aneurysms decreased to 50%, and five aneurysms decreased to 75%. Two aneurysms remained unchanged in size after 49 and 58 months, respectively. At the most recent clinical follow-up evaluation, symptoms of mass effect were cured in 19 (60%), improved in 10 (31%), and remained unchanged in three (9%) of the 32 patients.
Therapeutic carotid artery occlusion was a simple, safe, and effective treatment for large and giant carotid artery aneurysms. Almost all aneurysms involute completely or substantially decrease in size. Alleviation of symptoms of mass effect was achieved in most patients.
本研究旨在评估39例大型或巨大型颈动脉动脉瘤患者接受治疗性颈动脉闭塞术后中期的动脉瘤大小及临床症状。
1996年1月至2004年8月期间，39例大型或巨大型颈动脉动脉瘤患者接受了治疗性颈动脉闭塞术，并进行了至少3个月的临床及磁共振成像随访（平均35.9个月；中位数29个月；范围3 - 107个月；117患者-年）。39例患者中，32例（82%）最初的临床表现为动脉瘤引起的占位效应。3例患者出现蛛网膜下腔出血，1例出现鼻出血；2例动脉瘤为偶然发现，1例为另一个破裂动脉瘤之外的额外动脉瘤。
治疗性颈动脉闭塞术无早期或晚期并发症。早期及晚期磁共振成像和磁共振血管造影随访研究显示，颈动脉闭塞术后所有动脉瘤似乎均已完全血栓形成。在最近一次磁共振成像随访研究时，39例动脉瘤中有29例（74%）完全消退，2例动脉瘤直径减小至原来的25%，2例减小至50%，5例减小至75%。2例动脉瘤分别在49个月和58个月后大小未变。在最近一次临床随访评估时，32例患者中，19例（60%）占位效应症状治愈，10例（31%）改善，3例（9%）未变。
治疗性颈动脉闭塞术是治疗大型和巨大型颈动脉动脉瘤的一种简单、安全且有效的方法。几乎所有动脉瘤均完全消退或大小显著减小。大多数患者的占位效应症状得到缓解。
