Ringer Andrew J, Rodriguez-Mercado Rafael, Veznedaroglu Erol, Levy Elad I, Hanel Ricardo A, Mericle Robert A, Lopes Demetrius K, Lanzino Giuseppe, Boulos Alan S
Department of Neurosurgery, University of Cincinnati Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio 45267-0515, USA.
Neurosurgery. 2009 Aug;65(2):311-5; discussion 315. doi: 10.1227/01.NEU.0000349922.05350.96.
Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling.
Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days).
Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure.
Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.
颅内动脉瘤的血管内治疗比手术修复侵入性小，但动脉瘤复发风险更高，这可能需要再次治疗，从而增加长期风险。来自美国和波多黎各8家机构的脑血管神经外科医生合作评估初次血管内栓塞后残余或复发性动脉瘤再次治疗的风险。
前瞻性记录311例接受血管内栓塞治疗的颅内动脉瘤患者的数据，这些患者在血管造影或临床复发（初次栓塞后出血）后接受了352次再次治疗。分析的结果包括手术并发症和与手术相关的发病率。发病率分为严重（改良Rankin量表评分>3）或轻微，以及暂时（<30天）或永久（>30天）。
每次手术的再治疗死亡率为0.85%，每位患者为0.96%。与治疗相关的永久性或暂时性严重残疾发生率为每位患者0.32%（每次手术0.28%）；永久性轻度残疾发生率为1.29%（每次手术1.14%）；暂时性轻度残疾发生率为1.61%（每次手术1.42%）。死亡或永久性严重残疾的总风险为每位患者1.28%，每次手术1.13%。
初次栓塞后颅内动脉瘤复发患者再次治疗的风险较低；该风险小于初次血管内治疗的风险。在选择治疗方法时，必须前瞻性地考虑与动脉瘤复发再次治疗相关的残疾风险，但要认识到其在总体管理风险中的影响较低。
