Kang Hyun-Seung, Kwon Bae Ju, Kwon O-Ki, Jung Cheolkyu, Kim Jeong Eun, Oh Chang Wan, Han Moon Hee
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
J Neurosurg. 2009 Nov;111(5):963-9. doi: 10.3171/2009.4.JNS08934.
Anterior choroidal artery (AChA) aneurysms are difficult to treat, and the clinical outcome of patients is occasionally compromised by ischemic complications after clipping operations. The purpose of this study was to document the outcome and follow-up results of endovascular coil embolization in patients with AChA aneurysms.
Between July 1999 and March 2008, 88 patients with 90 AChA aneurysms (31 ruptured and 59 unruptured aneurysms) were treated with endovascular coil embolization in 91 sessions. There were 87 small aneurysms (< 10 mm) and 3 large aneurysms, with a mean aneurysm volume of 60.9 +/- 83.3 mm(3). Preprocedural oculomotor nerve palsy associated with AChA aneurysms was noted in 8 patients. Efficacy and safety were evaluated based on the degree of initial occlusion, procedure-related complications, patient outcome based on the Glasgow Outcome Scale score, and follow-up results.
The degree of angiographic occlusion of the aneurysms was complete for 15 aneurysms (17%), near complete for 69 aneurysms (77%) and partial for 6 aneurysms (7%). There were 4 (4.4%) symptomatic procedure-related complications (3 thromboembolic events and 1 procedural hemorrhage). The procedural hemorrhage resulted in death; however, the thromboembolic events only caused transient deficits. A favorable outcome (Glasgow Outcome Scale score of 5 or 4) was achieved in 90% (79 of 88) of the patients at the time of discharge. No patient showed signs of bleeding or rebleeding during the follow-up period (mean 25 months). Major aneurysm recanalization occurred in 2 cases. The AChA aneurysm-associated oculomotor nerve palsy tended to become aggravated transiently after coil embolization and then completely recovered over the course of 2-9 months.
Coil embolization is a safe and effective treatment modality in cases of AChA aneurysms. Coil embolization enables procedural recognition of arterial compromise and immediate reestablishment of flow, thus contributing to a favorable outcome.
脉络膜前动脉（AChA）动脉瘤难以治疗，夹闭手术后的缺血性并发症偶尔会影响患者的临床结局。本研究的目的是记录AChA动脉瘤患者血管内弹簧圈栓塞的结局和随访结果。
1999年7月至2008年3月期间，91例次对88例患有90个AChA动脉瘤（31个破裂动脉瘤和59个未破裂动脉瘤）的患者进行了血管内弹簧圈栓塞治疗。有87个小动脉瘤（<10 mm）和3个大动脉瘤，平均动脉瘤体积为60.9±83.3 mm³。8例患者术前存在与AChA动脉瘤相关的动眼神经麻痹。根据初始闭塞程度、与手术相关的并发症、基于格拉斯哥预后量表评分的患者结局以及随访结果评估疗效和安全性。
动脉瘤的血管造影闭塞程度为15个动脉瘤完全闭塞（17%），69个动脉瘤接近完全闭塞（77%），6个动脉瘤部分闭塞（7%）。有4例（4.4%）与手术相关的有症状并发症（3例血栓栓塞事件和1例手术出血）。手术出血导致死亡；然而，血栓栓塞事件仅引起短暂性神经功能缺损。出院时90%（88例中的79例）的患者获得了良好结局（格拉斯哥预后量表评分为5或4）。随访期间（平均25个月）无患者出现出血或再出血迹象。2例发生主要动脉瘤再通。AChA动脉瘤相关的动眼神经麻痹在弹簧圈栓塞后往往会短暂加重，然后在2 - 9个月内完全恢复。
弹簧圈栓塞是治疗AChA动脉瘤的一种安全有效的治疗方式。弹簧圈栓塞能够在手术过程中识别动脉损伤并立即恢复血流，从而有助于获得良好结局。
