Oishi Hidenori, Yoshida Kensaku, Shimizu Takashi, Yamamoto Munetaka, Horinaka Naoaki, Arai Hajime
Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2009 Jul;49(7):287-93. doi: 10.2176/nmc.49.287.
Middle cerebral artery (MCA) aneurysms often have unfavorable anatomical characteristics preventing successful endovascular occlusion. We reviewed the outcomes of our series of endosaccular embolization of MCA aneurysms using bare platinum coils, angiographic images, and medical records. Immediate and follow-up angiographic results were categorized as complete occlusion, residual neck, and residual flow. Follow-up angiographic changes were categorized as unchanged, minor or major recurrence, and progressive thrombosis. Between December 2001 and August 2007, 112 patients with 113 MCA aneurysms underwent endovascular treatment, of whom 60 presented with subarachnoid hemorrhage (SAH) due to MCA aneurysm rupture. Immediate angiographic outcomes for 103 aneurysms revealed complete occlusion in 64, residual neck in 21, residual flow in 18, and failed embolization in 10. Follow-up angiography of 70 aneurysms demonstrated 41 unchanged, 10 minor recurrences, 12 major recurrences, 7 progressive thromboses, and no bleeding of coil embolized aneurysms. Outcomes of 58 SAH patients treated endovascularly revealed 45 good recovery and moderate disability, 10 severe disability or persistent vegetative state, and 3 deaths. Forty-four of the 45 patients with unruptured aneurysms treated endovascularly had no changes in their neurological status. One of 5 patients with complications had permanent morbidity. For patients with MCA aneurysms suitable for endovascular surgery, bare platinum coil embolization can be performed with acceptable low morbidity and mortality rates, with a lower risk of postprocedural aneurysmal bleeding.
大脑中动脉（MCA）动脉瘤通常具有不利的解剖学特征，妨碍成功的血管内闭塞。我们回顾了我们使用裸铂弹簧圈对MCA动脉瘤进行囊内栓塞的系列病例的结果、血管造影图像和病历。即刻和随访血管造影结果分为完全闭塞、残余颈部和残余血流。随访血管造影变化分为无变化、轻微或严重复发以及进行性血栓形成。在2001年12月至200年8月期间，112例患有113个MCA动脉瘤的患者接受了血管内治疗，其中60例因MCA动脉瘤破裂出现蛛网膜下腔出血（SAH）。103个动脉瘤的即刻血管造影结果显示，64个完全闭塞，21个有残余颈部，18个有残余血流，10个栓塞失败。70个动脉瘤的随访血管造影显示，41个无变化，10个轻微复发，12个严重复发，7个进行性血栓形成，且弹簧圈栓塞的动脉瘤无出血。58例接受血管内治疗的SAH患者的结果显示，45例恢复良好和中度残疾，10例严重残疾或持续植物状态，3例死亡。45例接受血管内治疗的未破裂动脉瘤患者中，44例神经状态无变化。5例有并发症的患者中有1例有永久性病残。对于适合血管内手术的MCA动脉瘤患者，裸铂弹簧圈栓塞可在可接受的低发病率和死亡率下进行，术后动脉瘤出血风险较低。
