Wakhloo A K, Gounis M J, Sandhu J S, Akkawi N, Schenck A E, Linfante I
Department of Radiology, University of Massachusetts Medical School, Worcester, MA 02481, USA.
AJNR Am J Neuroradiol. 2007 Aug;28(7):1395-400. doi: 10.3174/ajnr.A0542.
Five to 60% of coiled brain aneurysms recanalize, generally because of coil compaction. In vitro exclusive use of complex-shaped coils allows better packing of the aneurysmal sac and the neck as compared with helical coils. We report a single-center, prospective study using complex coils. Safety, packing density, and recanalization rate were evaluated.
Seventy-seven aneurysms were embolized using complex coils alone. Aneurysms had a volume of 265 mm3 (diameter: 7.1+/-3.3 mm) and a neck size of 4.1+/-1.8 mm (range: 1.5-12 mm). Average follow-up available in 31 patients was 10.5+/-7.6 months (range: 3-36 months). Primary angiographic endpoints included aneurysmal recanalization and (re)rupture. Primary adverse events included stroke or death.
Complete or near-complete occlusion was achieved in all of the aneurysms but required balloon assistance in 24.6%. The packing density was computed as 37%+/-13%. No rerupture was observed during the follow-up interval. Recanalization was seen in 4 (12.9%) of 31. Two basilar tip aneurysms underwent a safe and complete recoiling. Periprocedural nondevice-related neurologic deficits were seen in 2 (2.9%) of 69 patients.
The use of complex-shaped coils allows higher packing density, which may improve the recanalization rate. Basilar tip aneurysms remain a challenge.
5%至60%的脑内盘绕型动脉瘤会再通，通常是由于弹簧圈压缩。与螺旋弹簧圈相比，体外单独使用复杂形状的弹簧圈可使动脉瘤囊和瘤颈得到更好的填充。我们报告一项使用复杂弹簧圈的单中心前瞻性研究。对安全性、填充密度和再通率进行了评估。
仅使用复杂弹簧圈栓塞77个动脉瘤。动脉瘤体积为265立方毫米（直径：7.1±3.3毫米），瘤颈大小为4.1±1.8毫米（范围：1.5至12毫米）。31例患者的平均随访时间为10.5±7.6个月（范围：3至36个月）。主要血管造影终点包括动脉瘤再通和（再）破裂。主要不良事件包括卒中或死亡。
所有动脉瘤均实现了完全或接近完全闭塞，但24.6%需要球囊辅助。计算得出填充密度为37%±13%。随访期间未观察到再破裂。31例中有4例（12.9%）出现再通。2例基底动脉尖动脉瘤进行了安全且完全的重新填塞。69例患者中有2例（2.9%）出现了与操作器械无关的围手术期神经功能缺损。
使用复杂形状的弹簧圈可实现更高的填充密度，这可能会提高再通率。基底动脉尖动脉瘤仍然是一个挑战。
