Consoli A, Renieri L, Mura R, Nappini S, Ricciardi F, Pecchioli G, Ammannati F, Mangiafico S
Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy.
Interv Neuroradiol. 2012 Mar;18(1):5-13. doi: 10.1177/159101991201800101. Epub 2012 Mar 16.
Endovascular treatment has assumed a role of first choice in the management of ruptured intracranial aneurysms. We describe the clinical and morphological data after the treatment of 258 ruptured intracranial aneurysms in 241 patients, in order to evaluate the safety and the efficacy of the endovascular treatment. Two hundred and forty-one patients with saccular ruptured aneurysms were treated at our institution between 2000 and 2005. After the endovascular treatment a clinical and angiographic follow-up was conducted. The clinical follow-up was carried out with a medical examination and telephonic interviews and mRS was used for evaluation. Two hundred and forty-nine acutely ruptured aneurysms were successfully treated and immediately after the endovascular procedure 81.9% of the aneurysms resulted completely occluded, 12.1% had a residual neck and 6% revealed a residual sac. The evolution of each grade was evaluated at six months and two years. During the follow-up we observed five early and one late re-bleedings. Twenty-four patients underwent a second procedure. After the discharge and up to ten years 73.1% of patients had a good clinical outcome (mRS0-1), 8.9% died and the remainder showed moderate-severe disability (mRS2-3). The long-term stability of the anatomical result is a critic-al issue of this approach because eventual re-bleedings may occur even after several months or years. A careful clinical and radiological follow-up for up to two years after the embolization may prevent recurrences but may not be sufficient.
血管内治疗已成为破裂颅内动脉瘤治疗的首选方法。我们描述了241例患者中258个破裂颅内动脉瘤治疗后的临床和形态学数据，以评估血管内治疗的安全性和有效性。2000年至2005年间，我们机构对241例囊状破裂动脉瘤患者进行了治疗。血管内治疗后进行了临床和血管造影随访。临床随访通过体格检查和电话访谈进行，并使用改良Rankin量表（mRS）进行评估。249个急性破裂动脉瘤得到成功治疗，血管内治疗后立即有81.9%的动脉瘤完全闭塞，12.1%有残余瘤颈，6%有残余瘤囊。在6个月和2年时评估每个分级的演变情况。随访期间，我们观察到5例早期再出血和1例晚期再出血。24例患者接受了二次治疗。出院后至10年，73.1%的患者临床预后良好（mRS 0 - 1），8.9%死亡，其余患者表现为中度至重度残疾（mRS 2 - 3）。解剖学结果的长期稳定性是这种治疗方法的一个关键问题，因为即使在数月或数年之后也可能发生最终的再出血。栓塞后长达两年的仔细临床和影像学随访可能预防复发，但可能并不足够。
