Department of Neurosurgery, Beijing Hospital, 1 Dahua Road Dongdan, Beijing 100730, China.
Eur J Radiol. 2012 Jun;81(6):1276-81. doi: 10.1016/j.ejrad.2011.03.005. Epub 2011 Mar 24.
Tiny intracranial aneurysms pose a significant therapeutic challenge for interventional neuroradiologists. The authors report their preliminary results of endovascular treatment of these aneurysms.
Between January 2002 and December 2009, 52 tiny intracranial aneurysms (defined as ≤ 3 mm in maximum diameter) in 46 patients (22 men; mean age, 57.9 years) were treated by endosaccular coil embolisation or sole stent deployment in the parent artery. Of 52 aneurysms, 29 had ruptured and 23 remained unruptured. The initial angiographic results, procedural complications, and clinical outcomes were assessed at discharge. Imaging follow-up was performed with cerebral angiography.
One aneurysm coiling procedure failed because of unsuccessful micro-catheterization. Forty-three aneurysms were successfully coil embolized, of which complete occlusion was obtained in 14, subtotal occlusion in 18 and incomplete occlusion in 11. The other 8 aneurysms were treated by sole stent deployment in the parent artery. Procedural complications (2 intraprocedural ruptures and 3 thromboembolic events) occurred in 5 (9.6%) of 52 aneurysms, resulting in permanent morbidity in only 1 (2.2%, 1/46) patient. No rebleeding occurred during clinical follow-up (mean duration, 46.7 months). Of the 16 coiled aneurysms that receiving repetitive angiography, 6 initially completely and 3 subtotally occluded aneurysms remained unchanged, 4 initially subtotally and 3 incompletely occluded aneurysms progressed to total occlusion. Five sole stent deployed aneurysms received angiographic follow-up (mean duration, 10.0 months), of which 3 remained unchanged, 1 became smaller and 1 progressed to total occlusion.
Endovascular treatment of tiny intracranial aneurysms is technical feasible and relatively safe. Coil embolisation seems to be effective in preventing early recanalisation, whereas sole stenting technique needs further investigation to determine its effectiveness.
微小颅内动脉瘤对介入神经放射学家来说是一个重大的治疗挑战。作者报告了他们对这些动脉瘤进行血管内治疗的初步结果。
在 2002 年 1 月至 2009 年 12 月期间，对 46 例患者（22 例男性；平均年龄 57.9 岁）的 52 个微小颅内动脉瘤（最大直径≤3mm）进行了血管内弹簧圈栓塞或单纯支架置入治疗。在 52 个动脉瘤中，29 个已破裂，23 个未破裂。出院时评估初始血管造影结果、手术并发症和临床结果。进行了影像学随访，包括脑血管造影。
1 个动脉瘤的线圈栓塞术因微导管插入不成功而失败。43 个动脉瘤成功进行了线圈栓塞，其中 14 个获得完全闭塞，18 个获得次全闭塞，11 个获得不完全闭塞。另外 8 个动脉瘤在母动脉内单独放置支架。52 个动脉瘤中有 5 个（9.6%）发生手术并发症（2 个术中破裂和 3 个血栓栓塞事件），仅 1 例（2.2%，46 例中的 1 例）发生永久性并发症。在临床随访期间无再出血发生（平均随访时间 46.7 个月）。在接受重复血管造影的 16 个线圈栓塞动脉瘤中，6 个初始完全闭塞和 3 个次全闭塞的动脉瘤保持不变，4 个初始次全闭塞和 3 个不完全闭塞的动脉瘤进展为完全闭塞。5 个单独放置支架的动脉瘤接受了血管造影随访（平均随访时间 10.0 个月），其中 3 个保持不变，1 个变小，1 个进展为完全闭塞。
血管内治疗微小颅内动脉瘤是可行且相对安全的。线圈栓塞似乎在预防早期再通方面有效，而单纯支架技术需要进一步研究以确定其有效性。
