Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Stroke. 2011 May;42(5):1331-7. doi: 10.1161/STROKEAHA.110.605790. Epub 2011 Mar 31.
In aneurysms that are adequately occluded 6 months after coiling, the risk of late reopening is largely unknown. We assessed the occurrence of late aneurysm reopening and possible risk factors.
From January 1995 to June 2005, 1808 intracranial aneurysms were coiled in 1675 patients at 7 medical centers. At 6 months, 1066 aneurysms in 971 patients were adequately occluded. At mean 6.0 years after coiling, of the 971 patients, 400 patients with 440 aneurysms underwent 3 Tesla magnetic resonance angiography to assess occlusion status of the aneurysms. Proportions and corresponding 95% CI of aneurysm reopening and retreatment were calculated. Risk factors for late reopening were assessed by univariate and multivariate logistic regression analysis, and included patient sex, rupture status of aneurysms, aneurysm size≥10 mm, and aneurysm location.
In 11 of 400 patients (2.8%; 95% CI, 1.4-4.9%) with 440 aneurysms (2.5%; 95% CI, 1.0-4.0%), late reopening had occurred; 3 reopened aneurysms were retreated (0.7%; 95% CI, 0.2-1.5%). Independent predictors for late reopening were aneurysm size≥10 mm (OR 4.7; 95% CI, 1.3-16.3) and location on basilar tip (OR 3.9; 95% CI, 1.1-14.6). There were no late reopenings in the 143 anterior cerebral artery aneurysms.
For the vast majority of adequately occluded intracranial aneurysms 6 months after coiling (those<10 mm and not located on basilar tip), prolonged imaging follow-up within the first 5 to 10 years after coiling does not seem beneficial in terms of detecting reopened aneurysms that need retreatment. Whether patients might benefit from screening beyond the 5- to 10-year interval is not yet clear.
在血管内栓塞治疗后 6 个月充分闭塞的动脉瘤中，迟发性再通的风险尚不清楚。本研究评估了迟发性动脉瘤再通的发生情况及其可能的危险因素。
1995 年 1 月至 2005 年 6 月，在 7 家医疗中心对 1675 名患者的 1808 个颅内动脉瘤进行了血管内栓塞治疗。在栓塞治疗后 6 个月时，971 名患者中的 1066 个动脉瘤得到了充分的闭塞。在血管内栓塞治疗后平均 6.0 年时，对 971 名患者中的 400 名患者（共 440 个动脉瘤）行 3.0T 磁共振血管造影检查，以评估动脉瘤的闭塞情况。计算动脉瘤再通和再治疗的比例及其相应的 95%置信区间。通过单因素和多因素逻辑回归分析评估迟发性再通的危险因素，包括患者性别、动脉瘤破裂状态、动脉瘤大小≥10mm 和动脉瘤位置。
在 400 名患者（2.8%；95%置信区间，1.4%～4.9%）的 440 个动脉瘤中（2.5%；95%置信区间，1.0%～4.0%），有 11 个动脉瘤发生了迟发性再通；其中 3 个再通的动脉瘤接受了再治疗（0.7%；95%置信区间，0.2%～1.5%）。迟发性再通的独立预测因素为动脉瘤大小≥10mm（OR 4.7；95%置信区间，1.3～16.3）和位于基底动脉顶端（OR 3.9；95%置信区间，1.1～14.6）。在 143 个前交通动脉动脉瘤中没有发生迟发性再通。
对于血管内栓塞治疗后 6 个月充分闭塞的绝大多数颅内动脉瘤（<10mm 且不位于基底动脉顶端），在血管内栓塞治疗后 5 至 10 年内进行延长影像学随访，在检测需要再治疗的再通动脉瘤方面似乎没有获益。患者是否可能从 5 至 10 年间隔后的筛查中获益尚不清楚。
