Department of Neurological Surgery, Wayne State University and the Detroit Medical Center, Detroit, Michigan 48201, USA.
J Neurointerv Surg. 2011 Dec 1;3(4):335-9. doi: 10.1136/jnis.2010.003889. Epub 2011 Apr 13.
There are limited data about the rate of recanalization following complete coil occlusion. Long term clinical and angiographic outcome of completely occluded intracranial aneurysms (IAs) by the endovascular approach are presented.
Over the course of 4 years, patients with IAs which were completely occluded by coiling at our institution were reviewed. Clinical and angiographic data were analyzed. The patients were clinically assessed using the Glasgow Outcome Scale (GOS). Follow-up angiographic findings were categorized as: stable aneurysm with no recanalization, recanalization with a neck remnant and recanalization with a body remnant.
83 aneurysms were identified in 74 patients (15 men and 59 women, average age 52.4 years) with complete occlusion post intervention. Treatment by coiling only was used in 73 aneurysms while stent assisted coiling was used in 10 cases. At the last angiographic follow-up (mean 16.3 months), 20 of the 83 aneurysms demonstrated various degrees of recanalization of which five had neck remnants and 15 had body remnants. The recanalization rate was significantly higher in large aneurysms (57%) compared with small aneurysms (14%). Clinically, 65 of the 74 patients showed good recovery (GOS score 5), eight had moderate disability (GOS score 4) and one was severely disabled (GOS score 3).
Complete endovascular occlusion of IA is certainly effective in preventing aneurysmal bleeding. However, recanalization rate, despite being lower when compared with subtotal occlusion, remains an issue. Longer follow-up is required.
完全闭塞线圈后再通率的数据有限。本文呈现了完全闭塞颅内动脉瘤（IA）的血管内治疗的长期临床和血管造影结果。
在 4 年的时间里，对我院完全闭塞的 IA 患者进行回顾性研究。分析临床和血管造影数据。采用格拉斯哥预后量表（GOS）对患者进行临床评估。随访的血管造影结果分为：稳定无再通的动脉瘤、有颈残端的再通和有体残端的再通。
74 例患者共 83 个动脉瘤在介入治疗后完全闭塞（15 例男性，59 例女性，平均年龄 52.4 岁）。仅用线圈治疗 73 个动脉瘤，支架辅助线圈治疗 10 个动脉瘤。在最后一次血管造影随访（平均 16.3 个月）中，83 个动脉瘤中有 20 个显示出不同程度的再通，其中 5 个有颈残端，15 个有体残端。大动脉瘤（57%）的再通率明显高于小动脉瘤（14%）。临床方面，74 例患者中有 65 例恢复良好（GOS 评分 5），8 例中度残疾（GOS 评分 4），1 例严重残疾（GOS 评分 3）。
IA 的完全血管内闭塞肯定能有效预防动脉瘤出血。然而，再通率仍然是一个问题，尽管与不完全闭塞相比，再通率较低。需要更长时间的随访。
