Department of Neuroradiology, University François Rabelais, Centre Hospitalier Universitaire Bretonneau, Tours, France.
AJNR Am J Neuroradiol. 2009 Nov;30(10):1986-92. doi: 10.3174/ajnr.A1744. Epub 2009 Aug 13.
The endovascular treatment (EVT) of cerebral aneurysms has experienced a revolution since 1991 with the introduction of platinum coil technology. During the past 10 years, there has been significant study of the feasibility of this technique, and clinical results of EVT have been published. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms still remains unknown. The purpose of this study was to evaluate the stability of anatomic occlusion of aneurysms and to assess the rate of recanalization and retreatment of these aneurysms.
Between January 1998 and December 2003, 1036 aneurysms (804 ruptured and 232 nonruptured) were treated consecutively with GDC coils in 5 neuroradiology centers. Procedural feasibility, acute angiographic occlusion results, morbidity, and mortality associated with this technique were assessed. All patients were regularly followed by digital subtraction angiography and MR imaging each year after treatment.
Initial acute angiographic results in 1036 aneurysms demonstrated total occlusion in 731 patients (70.5%), subtotal occlusion in 252 (24.3%), incomplete occlusion in 20 (1.9%), and failures in 33% (3.3%) aneurysms. A remodeling technique was used in 10%. A second procedure was performed for 72 aneurysms (7%). The total aneurysm follow-up time was 49,923 months (4160.25 aneurysm-years). The retreatment period was either in the months following initial treatment in aneurysms incompletely occluded or in years due to recanalization or de novo aneurysms. Fewer than 5 patients rebled during 10 years of follow-up. Long-term follow-up angiograms were obtained in 899 aneurysms, with 646 total, 230 subtotal, and 23 incomplete results.
Long-term follow-up of cerebral aneurysms is necessary to depict recanalization. Only 7% of the aneurysms were retreated. Use of bare coils gives a good long-term level of occlusion.
自 1991 年引入铂金线圈技术以来，颅内动脉瘤的血管内治疗（EVT）经历了一场革命。在过去的 10 年中，人们对这项技术的可行性进行了大量研究，并公布了 EVT 的临床结果。然而，Guglielmi 可解脱线圈（GDC）栓塞治疗颅内动脉瘤的长期耐久性仍不清楚。本研究旨在评估动脉瘤解剖学闭塞的稳定性，并评估这些动脉瘤的再通和再治疗率。
1998 年 1 月至 2003 年 12 月，在 5 个神经放射学中心连续对 1036 个动脉瘤（804 个破裂和 232 个未破裂）进行 GDC 线圈治疗。评估了该技术的操作可行性、急性血管造影闭塞结果、发病率和死亡率。所有患者在治疗后每年均通过数字减影血管造影和磁共振成像进行定期随访。
1036 个动脉瘤的初始急性血管造影结果显示，731 个患者（70.5%）完全闭塞，252 个患者（24.3%）次全闭塞，20 个患者（1.9%）不完全闭塞，33%（3.3%）的动脉瘤治疗失败。10%的患者采用了再塑形技术。72 个动脉瘤（7%）进行了第二次治疗。总的动脉瘤随访时间为 49923 个月（4160.25 个动脉瘤年）。治疗后未完全闭塞的动脉瘤在最初治疗后的几个月内或由于再通或新发生的动脉瘤而在数年内进行再治疗。在 10 年的随访中，少于 5 例患者再次出血。899 个动脉瘤获得了长期随访血管造影结果，其中 646 个完全闭塞，230 个次全闭塞，23 个不完全闭塞。
为了描绘再通，需要对颅内动脉瘤进行长期随访。只有 7%的动脉瘤需要再次治疗。使用裸圈可获得良好的长期闭塞效果。
