Fang Chun, Li Ming-Hua, Zhu Yue-Qi, Tan Hua-Qiao, Zhang Pei-Lei, Xu Hao-Wen, Wang Wu, Zhou Bin
Department of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Ann Vasc Surg. 2010 Apr;24(3):400-7. doi: 10.1016/j.avsg.2009.10.005. Epub 2009 Dec 29.
Endovascular embolization for very small cerebral aneurysms (VSCAs) is still controversial. We report our experience with endovascular coil embolization for these lesions and assess the feasibility and effectiveness.
We conducted a review of our experience with endovascular treatment of a series of 19 patients with 20 VSCAs, located at the supraclinoid segment of the internal cranial artery (ICA) in seven, the cavernous ICA segment in three, the anterior communicating artery in five, vertebral artery-posterior inferior cerebellar artery in two, bifurcation of the middle cerebral artery in one, the pericallosal artery in one, and the P2 segment in one. The World Federation of Neurosurgical Societies classification before treatment was grade I in 14 patients and grade II in five patients. The strategy of endovascular treatment included coil occlusion, balloon-assisted coiling, and stent-assisted coiling. Occlusion rate was divided into (1) total/near total, occlusion rate 95-100%; (2) subtotal, occlusion rate 80-95%; and (3) partial, occlusion rate<80%. Clinical outcome of patients with ruptured aneurysm was ascertained according to the Glasgow Outcomes Scale.
All patients were successfully treated with coil embolization; immediate angiography determined occlusion of the aneurysm, including total occlusion in five, subtotal occlusion in nine, and partial occlusion in six. During 1-2 years of follow-up, all aneurysms were confirmed as complete occlusion by control angiography. No recurrence or coil compaction occurred. No rehemorrhage or ischemic stroke occurred.
Endovascular coil embolization for VSCAs is effective and feasible. Initial subtotal or partial aneurysm occlusion might progress to total occlusion.
对于非常小的脑动脉瘤（VSCA），血管内栓塞治疗仍存在争议。我们报告我们对这些病变进行血管内弹簧圈栓塞的经验，并评估其可行性和有效性。
我们回顾了对19例患有20个VSCA患者的血管内治疗经验，这些动脉瘤位于7例患者的颈内动脉（ICA）鞍上段、3例患者的海绵窦段ICA、5例患者的前交通动脉、2例患者的椎动脉-小脑后下动脉、1例患者的大脑中动脉分叉处、1例患者的胼周动脉以及1例患者的P2段。治疗前世界神经外科协会联盟分级为I级的患者有14例，II级的患者有5例。血管内治疗策略包括弹簧圈栓塞、球囊辅助弹簧圈栓塞和支架辅助弹簧圈栓塞。闭塞率分为：（1）完全/接近完全闭塞，闭塞率95%-100%；（2）次全闭塞，闭塞率80%-95%；（3）部分闭塞，闭塞率<80%。根据格拉斯哥预后量表确定破裂动脉瘤患者的临床结局。
所有患者均成功接受弹簧圈栓塞治疗；即刻血管造影显示动脉瘤闭塞，其中完全闭塞5例，次全闭塞9例，部分闭塞6例。在1至2年的随访期间，对照血管造影证实所有动脉瘤均完全闭塞。未发生复发或弹簧圈压缩。未发生再出血或缺血性卒中。
血管内弹簧圈栓塞治疗VSCA是有效且可行的。最初的次全或部分动脉瘤闭塞可能进展为完全闭塞。
