Butteriss D, Gholkar A, Mitra D, Birchall D, Jayakrishnan V
Department of Neuroradiology, Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, United Kingdom.
AJNR Am J Neuroradiol. 2008 Jan;29(1):53-6. doi: 10.3174/ajnr.A0736. Epub 2007 Oct 5.
Endovascular treatment of intracranial aneurysms using platinum coils is effective, but uncommonly aneurysms recur. New-generation coils, such as Cerecyte, aim to address this problem. This study examines the safety and efficacy of these coils in the treatment of a cohort of ruptured and unruptured aneurysms
Sixty-seven patients with 68 aneurysms were included in the study. Of these, 51 were treated exclusively with the new polyglycolic acid (PGA)-containing coils, and 17 were treated with a combination of new PGA-containing and other coils. Initial and follow-up angiograms were graded according to the 3-point scale of occlusion. Follow-up angiography was available in 46 cases at 6 months. Based on occlusion grading at initial and follow-up angiography, aneurysms were classified into stable, improved, and worsened (recanalized) groups.
Of the exclusive new-coil cohort, 36 cases (70.6%) were initially completely occluded (grade 1), 12 (23.5%) showed filling at the neck (grade 2), and 3 (5.9%) showed contrast within the neck and sac (grade 3). Analysis of the follow-up angiograms showed 24 (70.6%) had stable occlusion, 3 (8.8%) had improved occlusion, and 7 (20.6%) had worsening occlusion. Data for cases treated with new PGA-containing coils together with bare platinum coils were also analyzed separately. Intraprocedural adverse events were noted in 4 cases (7.8%), but there were no clinical sequelae. There were no rebleeds in the follow-up period.
New PGA-containing coils show no excess in procedural and periprocedural complications over bare platinum coils, and the recanalization rate is comparable with bare platinum coils in the short term.
使用铂线圈进行颅内动脉瘤的血管内治疗是有效的,但动脉瘤复发并不常见。新一代线圈,如Cerecyte,旨在解决这一问题。本研究探讨了这些线圈在治疗一组破裂和未破裂动脉瘤中的安全性和有效性。
本研究纳入了67例患有68个动脉瘤的患者。其中,51例仅使用含新型聚乙醇酸(PGA)的线圈进行治疗,17例使用含新型PGA的线圈与其他线圈联合治疗。初始和随访血管造影根据3分闭塞量表进行分级。46例患者在6个月时进行了随访血管造影。根据初始和随访血管造影的闭塞分级,动脉瘤被分为稳定、改善和恶化(再通)组。
在仅使用新型线圈的队列中,36例(70.6%)初始时完全闭塞(1级),12例(23.5%)在颈部有造影剂充盈(2级),3例(5.9%)在颈部和瘤腔内有造影剂(3级)。对随访血管造影的分析显示,24例(70.6%)闭塞稳定,3例(8.8%)闭塞改善,7例(20.6%)闭塞恶化。对使用含新型PGA的线圈与裸铂线圈联合治疗的病例数据也进行了单独分析。术中不良事件记录在4例(7.8%)中,但无临床后遗症。随访期间无再出血发生。
含新型PGA的线圈在手术过程中和围手术期并发症方面并不比裸铂线圈多,且短期内再通率与裸铂线圈相当。