Willinsky R A, Peltz J, da Costa L, Agid R, Farb R I, terBrugge K G
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
AJNR Am J Neuroradiol. 2009 May;30(5):1035-40. doi: 10.3174/ajnr.A1488. Epub 2009 Mar 19.
Endovascular embolization is a well-established treatment of ruptured intracranial aneurysms, but concern about its long-term stability and its ability to prevent rehemorrhage are still present. We evaluated the long-term clinical and angiographic follow-up of patients with ruptured cerebral aneurysms treated with coiling, focusing on rehemorrhage and changes in aneurysm morphologic features.
A total of 377 patients with ruptured aneurysms that were treated with endovascular approaches at our institution between 1994 and 2008 were reviewed. Clinical and angiographic data were analyzed from a prospectively collected data base.
There were 377 patients with 391 ruptured aneurysms treated for 14 years. Good outcome (Glasgow Outcome Score [GOS], 5) was achieved in 74% of patients, moderate disability or poor outcome in 18%, and 8.8% died. Permanent morbidity or mortality from procedural complications occurred in 2.9%. Complete follow-up was available for 85% of surviving patients, with mean follow-up of 22.3 months. Re-treatment was required in 11% (31 patients). Eight (2.1%) patients had rebleeding, 6 (1.6%) in the hospital within 30 days of treatment, 5 in the first 48 hours. Follow-up imaging was available in 276 aneurysms in 270 patients. Recanalization occurred in 56 of 276 aneurysms (20.3%) regardless of the initial angiographic result, but the risk was higher if a body remnant was left (chi2, 11.791; P = .0006).
Long-term clinical and angiographic follow-up demonstrates the efficacy of endovascular treatment of ruptured intracranial aneurysms. Rebleeding after treatment is rare, with the greatest risk during the first 48 hours after treatment. Initial angiographic results are not a useful predictor of clinical outcome or rehemorrhage.
血管内栓塞术是治疗破裂颅内动脉瘤的一种成熟方法，但对其长期稳定性及预防再出血能力的担忧依然存在。我们评估了接受弹簧圈栓塞治疗的破裂脑动脉瘤患者的长期临床及血管造影随访情况，重点关注再出血及动脉瘤形态学特征的变化。
回顾了1994年至2008年间在我院接受血管内治疗的377例破裂动脉瘤患者。从前瞻性收集的数据库中分析临床及血管造影数据。
377例患者共391个破裂动脉瘤接受了14年的治疗。74%的患者预后良好（格拉斯哥预后评分[GOS]为5），18%的患者中度残疾或预后不良，8.8%的患者死亡。手术并发症导致的永久性致残或死亡发生率为2.9%。85%的存活患者获得了完整随访，平均随访时间为22.3个月。11%（31例患者）需要再次治疗。8例（2.1%）患者发生再出血，6例（1.6%）在治疗后30天内于医院内发生，5例在前48小时内发生。270例患者的276个动脉瘤有随访影像学资料。276个动脉瘤中有56个（20.3%）发生再通，无论初始血管造影结果如何，但如果留有瘤体残余，再通风险更高（χ2=11.791；P = 0.0006）。
长期临床及血管造影随访证明了血管内治疗破裂颅内动脉瘤的有效性。治疗后再出血罕见，治疗后前48小时风险最高。初始血管造影结果并非临床预后或再出血的有效预测指标。
