Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire Nancy, Nancy, France.
J Neurosurg. 2010 Apr;112(4):703-8. doi: 10.3171/2009.6.JNS09483.
The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution.
The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered.
At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years.
Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identical to other locations. Endovascular treatment may thus be proposed as an alternative to surgical clipping at this location. Nevertheless, a longer follow-up period is necessary to determine its efficacy, particularly in cases of unruptured aneurysms.
本研究旨在评估作者所在机构对大脑中动脉（MCA）动脉瘤进行血管内线圈栓塞的初始和中期血管造影及临床结果。
作者对 140 例 152 例 MCA 动脉瘤（73 例破裂）患者连续系列进行回顾性分析。前瞻性登记初始和中期随访的血管造影和临床数据以及与手术相关的并发症。
出院时，89.3%（125/140）的患者获得良好的临床结局（格拉斯哥结局量表评分 1 或 2）。7 名患者（5%）处于植物人状态或死亡。11.8%（18/152）的手术出现并发症，其中大多数（13/18）为血栓栓塞事件（导致 4 例永久性缺血和 1 例死亡）。总的手术相关死亡率为 0.7%，永久性和暂时性发病率分别为 2.6%和 2%。平均随访 4.3 年后，有 4 例再出血：3 例发生在术后早期，1 例发生在晚期。84.2%（128/152）的动脉瘤获得完全或近完全闭塞。随访时，治疗后 1 年、3 年和 5 年，110/132 例（83.3%）、89/112 例（79.5%）和 73/91 例（80.2%）的动脉瘤闭塞情况持续良好。
MCA 动脉瘤血管内治疗的风险以及初始和中期血管造影及临床结果与其他部位相似。因此，血管内治疗可作为该部位手术夹闭的替代方法。然而，需要更长的随访时间来确定其疗效，特别是在未破裂动脉瘤的情况下。
