Diagnostic Imaging and Interventional Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
J Neurointerv Surg. 2012 May;4(3):196-8. doi: 10.1136/neurintsurg-2011-010047. Epub 2011 Jul 7.
Coiling of small aneurysms can be technically challenging. These aspects of coiling tend to be less problematic in medium to large aneurysms as they are more accommodating of microcatheters and coils. When physicians are asked their opinion regarding aneurysm coilability in small aneurysms, the decision often lies in the operator's feeling that they could reasonably exclude the aneurysm with a complication rate similar to larger aneurysms. The purpose of our study was to investigate the feasibility, intraprocedural rupture rates and long term durability of endovascular coiling for small (≤4 mm) aneurysms compared with non-small (>4 mm) aneurysms. To control for factors such as vessel tortuosity and aneurysm location, a control group was chosen matched to the study group both in age and aneurysm location.
A retrospective review of 360 intracranial aneurysms coiled at our institution between 2003 and 2008 was performed. For the control group, intracranial aneurysms coiled in the same period matched to location and age were chosen.
The frequency of intraprocedural perforations was 4/34 (0.12) and 3/68 (0.04) for the small and non-small cohort, respectively (p=0.22). All patients who had a perforation in the small aneurysm groups had a good clinical outcome compared with 1/3 in the non-small group (two mortalities). The frequency of recanalization for the small and non-small groups was 3/34 (0.09) and 23/68 (0.33), respectively (p=0.006). There was no retreatments in the small aneurysm group and five (0.07) in the non-small group (p=0.116).
Coiling of small (≤4 mm) aneurysms is feasible with a reasonable complication rate. There is a non-significant increase in frequency of intraprocedural rupture with coiling of small aneurysms compared with controls matched to aneurysm location and age but this is not associated with increased morbidity. Coiling of small aneurysms leads to durable results at long term follow-up.
对小动脉瘤进行线圈栓塞可能具有技术挑战性。在中等至大动脉瘤中，这些线圈栓塞的方面往往不太成问题，因为它们更能容纳微导管和线圈。当医生被问及他们对小动脉瘤线圈可操作性的看法时，他们的决定往往取决于医生的感觉，即他们可以合理地排除动脉瘤，并且并发症发生率与大动脉瘤相似。我们研究的目的是调查与非小动脉瘤（>4mm）相比，对小（≤4mm）动脉瘤进行血管内线圈栓塞的可行性、术中破裂率和长期耐久性。为了控制血管迂曲和动脉瘤位置等因素，选择了与研究组在年龄和动脉瘤位置上相匹配的对照组。
回顾性分析了 2003 年至 2008 年在我院进行的 360 例颅内动脉瘤的线圈栓塞治疗。对于对照组，选择了同期在同一位置和年龄进行颅内动脉瘤线圈栓塞的患者。
小动脉瘤组和非小动脉瘤组的术中穿孔发生率分别为 4/34（0.12）和 3/68（0.04）（p=0.22）。所有在小动脉瘤组中发生穿孔的患者均有良好的临床转归，而非小动脉瘤组中只有 1/3的患者有此结果（两例死亡）。小动脉瘤组和非小动脉瘤组的再通率分别为 3/34（0.09）和 23/68（0.33）（p=0.006）。小动脉瘤组没有进行再治疗，而非小动脉瘤组有 5 例（0.07）（p=0.116）。
对小（≤4mm）动脉瘤进行线圈栓塞是可行的，并发症发生率合理。与匹配动脉瘤位置和年龄的对照组相比，小动脉瘤线圈栓塞术中破裂的频率略有增加，但这与增加的发病率无关。小动脉瘤的线圈栓塞在长期随访中可获得持久的结果。
