Renowden S A, Benes V, Bradley M, Molyneux A J
Department of Neuroradiology, Frenchay Hospital Bristol, Bristol, United Kingdom.
Clin Neurol Neurosurg. 2009 Feb;111(2):179-88. doi: 10.1016/j.clineuro.2008.09.026. Epub 2008 Nov 13.
The introduction of detachable coils revolutionised the management of patients with intracranial aneurysms and is now considered a first-line treatment in our institution. The purpose of this study was to review 10 years of experience with this method.
A retrospective review of prospectively collected data on 711 patients undergoing endovascular treatment of ruptured intracranial aneurysm between 1996 and 2005 with regard to technical feasibility, procedural complications, rebleeding, anatomical outcome, need for retreatment and overall clinical outcome.
Endovascular treatment failed in 25 aneurysms from a total of 717 (4%). Aneurysm rupture complicated 37 procedures (4.7%) leaving 10 patients permanently disabled or dead (1.3%). Thromboembolic events complicated 35 procedures (4.5%) leaving 8 patients permanently disabled or dead (1%). One other patient died because of fatal parent vessel rupture. Further 6 procedures were complicated by arterial dissection and 18 by coil loop protrusion, however all of these patients achieved independent recovery. Overall morbidity-mortality was 2.9%. Further subarachnoid hemorrhage occurred in 16 patients (2.3%), 12 of which died. Altogether, 121 aneurysms from 511 (24%) were recanalized on follow up angiography, 52 required retreatment (7.1%). At 6 months follow up, 580 patients (82%) were independent, while 130 patients (18%) were disabled or dead.
Detachable coil embolisation of intracranial aneurysms is a very feasible treatment method associated with a small risk of permanent morbidity-mortality. Risk of further bleeding is small, but related with devastating outcome. Approximately 25% of aneurysms will recanalize and 7% will require retreatment. Despite these shortcomings, vast majority of patients will achieve independent recovery.
可脱性弹簧圈的引入彻底改变了颅内动脉瘤患者的治疗方式，目前在本机构被视为一线治疗方法。本研究的目的是回顾采用该方法10年的经验。
回顾性分析1996年至2005年间前瞻性收集的711例颅内破裂动脉瘤患者接受血管内治疗的数据，内容包括技术可行性、手术并发症、再出血、解剖学结果、再次治疗需求及总体临床结果。
在总共717个动脉瘤中，25个（4%）血管内治疗失败。37例手术（4.7%）并发动脉瘤破裂，导致10例患者永久性残疾或死亡（1.3%）。35例手术（4.5%）并发血栓栓塞事件，导致8例患者永久性残疾或死亡（1%）。另有1例患者因致命的载瘤血管破裂死亡。还有6例手术并发动脉夹层，18例并发弹簧圈圈突，不过所有这些患者均实现独立康复。总体病亡率为2.9%。16例患者（2.3%）发生再发蛛网膜下腔出血，其中12例死亡。总共511个动脉瘤中有121个（24%）在随访血管造影时出现再通，52个（7.1%）需要再次治疗。在6个月随访时，580例患者（82%）可独立生活，而130例患者（18%）残疾或死亡。
颅内动脉瘤可脱性弹簧圈栓塞术是一种非常可行的治疗方法，永久性病亡风险较小。再出血风险小，但后果严重。约25%的动脉瘤会再通，7%需要再次治疗。尽管有这些不足，但绝大多数患者将实现独立康复。
