Yang Ming-Shiang, Wong Ho-Fai, Yang Tzu-Hsien, Chen Yao-Liang, Chan Si-Wa, Lee Huey-Jen, Tung Yung Wei, Tu Chung-Wei, Chen Tai-Yi
Department of Radiology, China Medical University Hospital, Taichung 404, Taiwan.
Surg Neurol. 2009 Dec;72 Suppl 2:S41-6. doi: 10.1016/j.wneu.2009.09.003.
To evaluate the safety and protective effect of relative undersized coil with loose coil core in the clinical dilemma condition--very small (43.0 mm) ruptured intracranial aneurysm.
We studied 12 patients (4 men, 8 women) who had suffered from acute ruptured small intracranial aneurysms (2-3 mm in size, with SAH presentation). All subjects underwent a single coil embolization procedure. An undersized coil (equivalent to the neck size or 0.5 mm smaller than the aneurysm diameter) was chosen as the embolizer. Based on the postembolization angiogram, subjects were divided into 2 groups. One was labeled as the initial complete obliteration group (NR) and the other as the incomplete obliteration group (SR). Fisher exact test and the Wilcoxon rank sum test were used to for statistical analysis.
The technical success rate was 100% without any procedure-related complication. The follow-up interval ranged from 6 to 32 months. No episode of rebleeding or coil migration could be defined in the admissive and following period. Loose coil core were seen in all patients. The total recurrent rate was 8.3% (1/12); only one patient suffered from recurrent lesion in SR group.
The preliminary result showed that under-sized coil packing with loose coil core could provide the protective effect and prevent from further rebleeding for very small ruptured aneurysms. It should be considered as an alternative option in the treatment of acute ruptured very small aneurysms when other conventional strategies are not feasible.
评估在临床困境——非常小（43.0毫米）的破裂颅内动脉瘤中，具有松散线圈核心的相对尺寸较小的线圈的安全性和保护作用。
我们研究了12例患者（4例男性，8例女性），他们患有急性破裂的小型颅内动脉瘤（大小为2 - 3毫米，伴有蛛网膜下腔出血表现）。所有受试者均接受了单次线圈栓塞手术。选择尺寸较小的线圈（相当于颈部尺寸或比动脉瘤直径小0.5毫米）作为栓塞剂。根据栓塞后血管造影，将受试者分为2组。一组标记为初始完全闭塞组（NR），另一组为不完全闭塞组（SR）。采用Fisher精确检验和Wilcoxon秩和检验进行统计分析。
技术成功率为100%，无任何与手术相关的并发症。随访间隔为6至32个月。在允许期及后续期间未发现再出血或线圈移位事件。所有患者均可见松散的线圈核心。总复发率为8.3%（1/12）；仅SR组有1例患者出现复发病变。
初步结果表明，带有松散线圈核心的尺寸较小的线圈填充可为非常小的破裂动脉瘤提供保护作用并防止进一步再出血。当其他传统策略不可行时，它应被视为治疗急性破裂的非常小的动脉瘤的一种替代选择。
