Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Neurol Neurosurg Psychiatry. 2010 Jan;81(1):74-9. doi: 10.1136/jnnp.2009.171967. Epub 2009 Aug 16.
To report our experiences in the treatment of recurrent intracranial aneurysms with re-coiling or covered stents.
A total of 291 patients with 305 intracranial aneurysms were treated with detachable coils, and 41 (28.9%) of 142 patients with aneurysms in the internal carotid artery had a recurrent aneurysm during the follow-up period. For this study, 31 recurrent aneurysms in 31 patients who had angiograms within 6 months following retreatment with detachable coils (group A, n = 20) or covered stents (group B, n = 11) were analysed. Aneurysms were categorised as complete or incomplete occlusion via angiographic assessment and graded as full recovery, improvement, no change or deterioration via clinical assessment. Data regarding technical success, initial and final angiographic results, mortality, morbidity and final clinical outcome were collected and analysed postoperatively.
Coil embolisation and covered stent placement were technically successful in all recurrent aneurysms. The initial angiographic results showed complete occlusion in 11 patients (55%) in group A and in eight (72.7%) in group B (p = 0.452), and the final angiographic results exhibited complete occlusion in 10 patients (50%) in group A and in 11 (100%) in group B (p = 0.005). There were no significant differences in technique success, mortality, culminate morbidity or final clinical outcome between the two groups.
Recurrent aneurysms after coiling can be successfully treated and occluded with re-coiling or covered stent placement. However, covered stents seem to be more effective than re-coiling with regard to complete occlusion of recurrent aneurysms.
报告我们使用可解脱弹簧圈或覆膜支架对复发性颅内动脉瘤进行再治疗的经验。
共对 291 例 305 个颅内动脉瘤患者行可解脱弹簧圈栓塞治疗，其中 142 例颈内动脉动脉瘤患者中有 41 例（28.9%）在随访期间出现动脉瘤复发。本研究分析了在可解脱弹簧圈再次治疗后 6 个月内行血管造影检查的 142 例患者中的 31 个复发性动脉瘤（A 组 n=20，行可解脱弹簧圈再治疗；B 组 n=11，行覆膜支架再治疗）。通过血管造影评估将动脉瘤分为完全或不完全闭塞，并通过临床评估将其分为完全恢复、改善、无变化或恶化。收集并分析了术后技术成功率、初始和最终血管造影结果、死亡率、发病率和最终临床结局的数据。
所有复发性动脉瘤的弹簧圈栓塞和覆膜支架置入技术均成功。初始血管造影结果显示 A 组 11 例（55%）和 B 组 8 例（72.7%）患者完全闭塞（p=0.452），最终血管造影结果显示 A 组 10 例（50%）和 B 组 11 例（100%）患者完全闭塞（p=0.005）。两组之间的技术成功率、死亡率、最终发病率或最终临床结局无显著差异。
弹簧圈治疗后的复发性动脉瘤可以通过再次弹簧圈栓塞或覆膜支架置入来成功治疗和闭塞。然而，与再次弹簧圈栓塞相比，覆膜支架似乎更能有效实现复发性动脉瘤的完全闭塞。
