Ringer Andrew J, Lanzino Giuseppe, Veznedaroglu Erol, Rodriguez Rafael, Mericle Robert A, Levy Elad I, Hanel Ricardo A, Lopes Demetrius K, Boulos Alan S
Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0515, USA.
Neurosurgery. 2008 Nov;63(5):845-9; discussion 849. doi: 10.1227/01.NEU.0000333261.63818.9C.
Endovascular treatment of intracranial aneurysms is a less invasive alternative than surgical repair. However, the higher risk of recurrence after coiling necessitates regular angiographic surveillance, which has associated risks. To date, the risk of surveillance angiography has not been quantified in patients with intracranial aneurysms treated by endovascular embolization.
Angiograms performed for the surveillance of coiled intracranial aneurysms in patients treated at 8 institutions were recorded prospectively. Of 3086 patients eligible for surveillance angiography according to each institution's protocol during the study period, 2243 patients (72.7%) underwent this procedure. Data were reviewed retrospectively, including the results of each angiogram, angiographic complications, and morbidity resulting from the procedure. Morbidity was classified as major (modified Rankin Scale score >or=3) or minor (modified Rankin Scale score <3) and as temporary (<30 days) or permanent (>or=30 days).
Of 2814 diagnostic angiograms performed, 12 resulted in complications, including 1 (0.04%) permanent major morbidity, 2 (0.07%) temporary major morbidities, and 9 (0.32%) temporary minor morbidities; 6 of these were access site complications). No mortality or permanent minor morbidity was noted.
In this study, routine angiographic surveillance after endovascular treatment of aneurysms has a very low complication rate (0.43%). Incorporating these initial findings with the rate and risk of recurrent treatment or the risk of hemorrhage after coiling will provide a more accurate estimate of the global long-term risk of aneurysm coiling.
颅内动脉瘤的血管内治疗是一种比手术修复侵入性更小的替代方法。然而，栓塞后复发风险较高，因此需要定期进行血管造影监测，而这也存在相关风险。迄今为止，对于接受血管内栓塞治疗的颅内动脉瘤患者，监测性血管造影的风险尚未进行量化。
前瞻性记录在8家机构接受治疗的患者为监测颅内动脉瘤栓塞情况而进行的血管造影。在研究期间，根据各机构方案有资格接受监测性血管造影的3086例患者中，2243例（72.7%）接受了该检查。对数据进行回顾性分析，包括每次血管造影的结果、血管造影并发症以及该检查导致的发病率。发病率分为严重（改良Rankin量表评分≥3）或轻微（改良Rankin量表评分＜3），以及短暂性（＜30天）或永久性（≥30天）。
在进行的2814次诊断性血管造影中，12次出现并发症，包括1例（0.04%）永久性严重发病、2例（0.07%）短暂性严重发病和9例（0.32%）短暂性轻微发病；其中6例为穿刺部位并发症。未观察到死亡或永久性轻微发病情况。
在本研究中，动脉瘤血管内治疗后的常规血管造影监测并发症发生率非常低（0.43%）。将这些初步结果与复发治疗的发生率和风险或栓塞后出血风险相结合，将能更准确地评估动脉瘤栓塞的总体长期风险。
