Sedat J, Chau Y, Moubarak K, Vargas J, Lonjon M
Unité de Neuroradiologie Interventionnelle, Hôpital St Roch CHU, Nice, France.
Interv Neuroradiol. 2012 Mar;18(1):14-9. doi: 10.1177/159101991201800102. Epub 2012 Mar 16.
Recurrence is the main drawback of aneurysmal coiling. Additional coiling must sometimes be considered in patients with reopened aneurysms and expose the patient to the risk of a new procedure. Our purpose was to assess the procedural complications of additional endovascular treatments in patients with previously coiled but recurrent aneurysms treated by two neurointerventionalists during a decade in a single center. Between 1999 and 2009, 637 intracranial aneurysms were coiled and had a clinical and angiographic follow-up at our institution. Following the first embolization, 44 aneurysms were retreated with coils and 11 were retreated a second time. Retreatment was decided when a recurrence showed at angiographic follow-up. Early retreatments, performed in the first month after an incomplete or failed initial coiling, were excluded. We retrospectively analysed the procedural complications, rebleeding, clinical and angiographic outcomes of the retreatments. No death or bleeding occurred in these 55 additional procedures. We had three periprocedural thromboembolic complications and the procedural permanent morbidity was 1.8%. Clinical and angiographic follow-ups ranged from six months to nine years (mean: 37 months, median: 36 months). Thirty-seven of the 44 retreated aneurysms (84%) showed a stable occlusion at follow-up. Seven showed a recurrence but were not retreated due to the stability of the packing. No rebleeding was observed during the follow-up period. Our results show that endovascular treatment of recurrent aneurysms is associated with a low procedural risk.
复发是动脉瘤栓塞术的主要缺点。对于动脉瘤复发的患者，有时必须考虑再次进行栓塞，这会使患者面临新手术的风险。我们的目的是评估在单一中心，由两位神经介入医生在十年间对先前已行栓塞但复发的动脉瘤患者进行额外血管内治疗的手术并发症。1999年至2009年间，我们机构对637例颅内动脉瘤进行了栓塞治疗，并进行了临床和血管造影随访。首次栓塞后，44例动脉瘤接受了再次栓塞，11例接受了第二次栓塞。当血管造影随访显示复发时决定进行再次治疗。排除在首次不完全或失败的栓塞术后第一个月内进行的早期再次治疗。我们回顾性分析了再次治疗的手术并发症、再出血情况、临床及血管造影结果。这55例额外手术中无死亡或出血发生。我们有3例围手术期血栓栓塞并发症，手术永久性致残率为1.8%。临床和血管造影随访时间为6个月至9年（平均：37个月，中位数：36个月）。44例接受再次栓塞的动脉瘤中，37例（84%）在随访时显示栓塞稳定。7例显示复发，但由于填塞稳定未再次治疗。随访期间未观察到再出血。我们的结果表明，复发性动脉瘤的血管内治疗手术风险较低。
