Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Neuroimaging. 2010 Jan;20(1):70-3. doi: 10.1111/j.1552-6569.2008.00324.x.
We sought to report our technical success and complications in treating distal anterior cerebral artery (ACA) aneurysms with coil embolization.
We retrospectively reviewed all patients undergoing coil embolization of distal ACA aneurysms from September 1999 to March 2008. Patients were assessed for subarachnoid hemorrhage, fundus size, and fundus-to-neck ratio (F/N) < 2 or >or= 2. Technical success for aneurysms was assessed according to established criteria immediately post-procedure and at 6-month angiographic follow-up. Post-procedural outcomes were measured using the modified Rankin Scale (mRS) at discharge. A mRS <or= 2 for ruptured aneurysms or no change from baseline for unruptured aneurysms was considered a good clinical outcome.
Based on an intention-to-treat principle, we attempted embolization of 28 distal ACA aneurysms in 26 patients and were technically successful in 26 aneurysms (93%). Our mean age was 58 +/- 11 years. Thirteen presented with acute rupture. Average aneurysm size was 5.7 +/- 2.8 mm in our cohort with 20/28 (71%) having an F/N >or= 2. Seventeen aneurysms with an F/N >or= 2 and 5 with an F/N < 2 were completely obliterated or had minimal neck remnants at the end of the procedure (79%). Fourteen aneurysms underwent 6-month angiographic follow-up and were either completely obliterated or had a minimal residual neck remnant. Clinical outcomes were good in 12/13 unruptured patients (93%) at the time of discharge and in 6/13 ruptured patients (46%) with 90-day follow-up. Three patients had ischemic complications that were considered non-disabling, and 2 patients died from complications related to their initial subarachnoid hemorrhage. Two patients had an aborted procedure from failure to catheterize the aneurysm.
Endovascular treatment of distal ACA aneurysms can achieve good technical and clinical outcomes.
我们旨在报告应用线圈栓塞治疗大脑前动脉远端（ACA）动脉瘤的技术成功率和并发症。
我们回顾性分析了 1999 年 9 月至 2008 年 3 月期间所有接受大脑前动脉远端动脉瘤线圈栓塞的患者。根据蛛网膜下腔出血、眼底大小和瘤颈比（F/N）＜2 或≥2 对患者进行评估。根据既定标准评估即刻术后和 6 个月血管造影随访时的动脉瘤技术成功率。出院时采用改良 Rankin 量表（mRS）评估术后结果。破裂动脉瘤 mRS＜2 或未破裂动脉瘤与基线相比无变化被认为是良好的临床结果。
基于意向治疗原则，我们对 26 例患者的 28 个大脑前动脉远端动脉瘤进行了栓塞尝试，其中 26 个动脉瘤（93%）达到了技术成功。我们的平均年龄为 58±11 岁，13 例为急性破裂。平均动脉瘤大小为 5.7±2.8mm，28 个动脉瘤中有 20 个（71%）的 F/N≥2。17 个 F/N≥2 的动脉瘤和 5 个 F/N＜2 的动脉瘤在手术结束时完全闭塞或仅有微小的瘤颈残留（79%）。14 个动脉瘤进行了 6 个月的血管造影随访，结果均为完全闭塞或仅有微小的瘤颈残留。13 例未破裂患者中有 12 例（93%）在出院时和 6 例破裂患者（46%）在 90 天随访时临床结果良好。3 例患者发生缺血性并发症，认为非致残性，2 例患者因初始蛛网膜下腔出血相关并发症死亡。2 例患者因未能置入股动脉而中止手术。
血管内治疗大脑前动脉远端动脉瘤可获得良好的技术和临床结果。
