Piske Ronie L, Kanashiro Luis H, Paschoal Eric, Agner Celso, Lima Sergio S, Aguiar Paulo H
Section of Interventional Neuroradiology, Med Imagem, Hospital Beneficencia Portuguesa, São Paulo, Brazil.
Neurosurgery. 2009 May;64(5):E865-75; discussion E875. doi: 10.1227/01.NEU.0000340977.68347.51.
We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils.
Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck >4 mm and/or dome-to-neck ratio <1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to <25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months.
Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%.
Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.
我们报告使用Onyx HD - 500（微治疗公司，加利福尼亚州欧文市）对宽颈颅内动脉瘤进行血管内治疗的结果，此类动脉瘤使用铂圈治疗时不完全闭塞和再通率较高。
对69例患者的84个动脉瘤进行了治疗。大多数动脉瘤位于前循环（84个动脉瘤中的80个），未破裂（84个动脉瘤中的74个），且为偶然发现。10例表现为蛛网膜下腔出血，15例有症状。所有动脉瘤均有宽颈（颈径>4 mm和/或瘤顶与颈径之比<1.5）。50个动脉瘤较小（<12 mm），30个较大（12至<25 mm），4个为巨大动脉瘤。84个动脉瘤中有65个在6个月时、31个在18个月时、5个在36个月时进行了血管造影随访。
即刻造影显示65.5%的动脉瘤完全闭塞，6个月时为84.6%，18个月时为90.3%。在相同随访期，小动脉瘤的完全闭塞率分别为74%、95.1%和95.2%，大动脉瘤分别为53.3%、70%和80%。所有动脉瘤中有68.2%从不完全闭塞进展为完全闭塞，小动脉瘤的比例更高（90.9%）。3例患者（4.6%）观察到动脉瘤再通，2例患者（3.3%）进行了再次治疗。手术死亡率为2.9%。总体发病率为7.2%。
颅内宽颈动脉瘤的Onyx栓塞术安全有效。发病率和死亡率与其他当前血管内技术相似。需要更大样本和更长随访期。
