Chalouhi Nohra, Jabbour Pascal, Tjoumakaris Stavropoula, Dumont Aaron S, Chitale Rohan, Rosenwasser Robert H, Gonzalez L Fernando
Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA.
Clin Neurol Neurosurg. 2013 May;115(5):607-13. doi: 10.1016/j.clineuro.2012.07.028. Epub 2012 Aug 18.
Balloon-assisted coil embolization (BACE) has been widely used for the treatment of intracranial aneurysms. The routine use of this technique remains, however, controversial. In this study, we review our experience with BACE with respect to the indications, complications and effectiveness of the technique.
A retrospective review was conducted on 76 BACE procedures performed at a single institution between June 2009 and June 2011.
Of 76 aneurysms (40 ruptured and 36 unruptured) treated with BACE, 64 were located in the anterior circulation and 12 in the posterior circulation. The mean aneurysm size was 6.8mm. A balloon was used for parent vessel protection in 56, side-branch protection in 12 and balloon-in-stent coiling in 8 patients. 75 aneurysms (98.6%) were successfully coiled with a mean packing density of 28.3%. Thromboembolic complications developed after the treatment of 5 aneurysms (6.6%) causing transient morbidity in 4 patients (5.2%). One balloon-unrelated rupture occurred with no significant extravasation due to temporary balloon occlusion. There were no procedure-related permanent morbidity or deaths. 47 patients had imaging follow-up (angiogram in 28, MRA in 19) at a mean timepoint of 7.8 months. 45 patients (95.7%) had complete or near-complete occlusion while 2 patients (4.3%) had major recurrences, one underwent surgical clipping and the other had stent-assisted coiling. One patient had a rehemorrhage (1.3%).
In our experience, BACE has low complication and recurrence rates in the treatment of complex and wide-necked intracranial aneurysms. High packing densities were achieved with BACE technique.
球囊辅助弹簧圈栓塞术（BACE）已广泛应用于颅内动脉瘤的治疗。然而，该技术的常规使用仍存在争议。在本研究中，我们回顾了我们在BACE技术的适应证、并发症及有效性方面的经验。
对2009年6月至2011年6月在单一机构进行的76例BACE手术进行回顾性研究。
在接受BACE治疗的76个动脉瘤（40个破裂，36个未破裂）中，64个位于前循环，12个位于后循环。动脉瘤平均大小为6.8mm。56例使用球囊保护载瘤动脉，12例用于保护分支血管，8例采用球囊辅助支架置入弹簧圈栓塞术。75个动脉瘤（98.6%）成功栓塞，平均填充密度为28.3%。5个动脉瘤（6.6%）治疗后发生血栓栓塞并发症，导致4例患者（5.2%）出现短暂性发病。1例与球囊无关的动脉瘤破裂，因球囊临时闭塞未出现明显外渗。无手术相关的永久性发病或死亡。47例患者进行了影像学随访（28例行血管造影，19例行磁共振血管造影），平均随访时间为7.8个月。45例患者（95.7%）实现了完全或近乎完全闭塞，2例患者（4.3%）出现严重复发，1例接受了手术夹闭，另1例接受了支架辅助弹簧圈栓塞术。1例患者发生再出血（1.3%）。
根据我们的经验，BACE治疗复杂和宽颈颅内动脉瘤的并发症和复发率较低。BACE技术可实现高填充密度。
