Vanzin J R, Mounayer C, Abud D G, D'agostini Annes R, Moret J
Interventional Neuroradiology, Neurology and Neurosurgery Service, Passo Fundo, Brazil.
Interv Neuroradiol. 2012 Dec;18(4):391-400. doi: 10.1177/159101991201800405. Epub 2012 Dec 3.
This study was designed in an attempt to identify the risk factors that could be significantly associated with angiographic recurrences after selective endovascular treatment of aneurysms with inert platinum coils. A retrospective analysis of all patients with selective endovascular coil occlusion of intracranial aneurysms was prospectively collected from 1999 to 2003. There were 455 aneurysms treated with inert platinum coils and followed by digital subtraction angiography. Angiographic results were classified according Roy and Raymond's classification. Recurrences were subjectively divided into minor and major. The most significant predictors for angiographic recurrences were determined by ANOVAs logistic regression, Cochran-Mantel-Haenszel test, Fisher exact probability. Short-term (4.3 ± 1.4 months) follow-up angiograms were available in 377 aneurysms, middle-term (14.1 ± 4.0 months) in 327 and long-term (37.4 ± 11.5 months) in 180. Recurrences were found in 26.8% of treated aneurysms with a mean of 21 ± 15.7 months of follow-up. Major recurrences needing retreatment were present in 8.8% during a mean period follow-up of 17.9 ± 12.29 months after the initial endovascular treatment. One patient (0.2%) experienced a bleed during the follow-up period. Recurrences after endovascular treatment of aneurysms with inert platinum coils are frequent, but hemorrhages are unusual. Single aneurysm, ruptured aneurysm, neck greater than 4 mm and time of follow-up were risk factors for recurrence after endovascular treatment. The retreatment of recurrent aneurysm decreases the risk of major recurrences 9.8 times. Long-term angiogram monitoring is necessary for the population with significant recurrence predictors.
本研究旨在确定在使用惰性铂线圈对动脉瘤进行选择性血管内治疗后，可能与血管造影复发显著相关的危险因素。对1999年至2003年期间前瞻性收集的所有接受颅内动脉瘤选择性血管内线圈栓塞治疗的患者进行回顾性分析。共有455个动脉瘤接受了惰性铂线圈治疗，并随后进行了数字减影血管造影。血管造影结果根据罗伊和雷蒙德分类法进行分类。复发被主观分为轻度和重度。通过方差分析的逻辑回归、 Cochr an - Mantel - Haenszel检验、费舍尔精确概率法确定血管造影复发的最显著预测因素。377个动脉瘤有短期（4.3±1.4个月）随访血管造影，327个有中期（14.1±4.0个月）随访血管造影，180个有长期（37.4±11.5个月）随访血管造影。在平均随访21±15.7个月的已治疗动脉瘤中，26.8%出现复发。在初始血管内治疗后平均随访17.9±12.29个月期间，8.8%的患者出现需要再次治疗的重度复发。1例患者（0.2%）在随访期间发生出血。使用惰性铂线圈对动脉瘤进行血管内治疗后复发很常见，但出血不常见。单个动脉瘤、破裂动脉瘤、瘤颈大于4mm以及随访时间是血管内治疗后复发的危险因素。复发性动脉瘤的再次治疗将重度复发风险降低9.8倍。对于有显著复发预测因素的人群，长期血管造影监测是必要的。
