Batista L L, Mahadevan J, Sachet M, Alvarez H, Rodesch G, Lasjaunias P
Service de Neuroradiologie Vasculaire Diagnostique et Thérapeutique, CHU de Bicêtre, Le Kremlin-Bicêtre; France -
Interv Neuroradiol. 2002 Dec 22;8(4):349-66. doi: 10.1177/159101990200800405. Epub 2004 Oct 20.
The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a mid- term (3 years) and 45 patients had a 5-year or more angiographic FU (mean 67,7 months per patient). Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5-year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos- embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. No mortality related to the procedure was observed in the unruptured AA group.No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long-term with stable morphological results provided a strict follow-up control is established at short term.
本文的目的是对栓塞的硬脊膜内囊状动脉瘤（AA）进行随访，不包括巨大型、夹层型、炎症型、梭形或与BVAM相关的动脉瘤。自1991年引入以来， Guglielmi可脱卸弹簧圈（Guglielmi Detachable Coil）在蛛网膜下腔出血（SAH）后的关键几天和几个月内，无论分级如何，都能防止动脉瘤再出血。仍有一些问题存在：首次栓塞时是否需要完全血管造影闭塞？需要多长时间的临床/血管造影随访（FU）以确保出血风险已消除？对再出血的长期保护作用如何？本研究选取了1997年4月前栓塞的102例硬脊膜内囊状AA患者。他们至少有5年的临床随访，其中22例患者有中期（3年）随访，45例患者有5年或更长时间的血管造影随访（平均每位患者67.7个月）。28个在1年时栓塞的AA达到100%闭塞，在5年血管造影时保持不变。另外14例在1年时完全闭塞的患者在3年随访血管造影时仍显示持续完全闭塞，在我们的系列研究中，这意味着栓塞后第1年完全闭塞意味着动脉瘤将保持完全闭塞。所有继发性自发血栓形成（占病例的27.6%）均发生在栓塞后的第1年。6例次全或部分闭塞的患者在连续3年的随访中未见变化；在5年血管造影时均未显示后期变化。闭塞率低于80%时，我们的系列研究没有提供足够信息，但我们认为这种情况不稳定。在未破裂AA组中未观察到与手术相关的死亡。自我们（1993年）开始用GDC弹簧圈治疗囊状AA以来，未发生出血或再出血。对适当选择的患者进行弹簧圈栓塞在短期和长期内有效地防止出血或再出血，且形态学结果稳定，前提是在短期内建立严格的随访控制。
