Katedra i Klinika Neurochirurgii, Warszawski Uniwersytet Medyczny, Warszawa, Poland.
Neurol Neurochir Pol. 2013 Jan-Feb;47(1):18-26. doi: 10.5114/ninp.2012.31549.
The aim of this retrospective study was to assess the effectiveness of aneurysm clipping by computed tomography angiography (CTA) in a long-term follow-up.
The CTA examination was performed in 119 patients who had 143 aneurysms clipped. The examinations were performed 3 to 11 years (mean 6 years) after clipping using a GE Lightspeed PRO16 scanner.
In all cases but one, good quality CTA images, suitable for evaluation of the arteries around the clip site, were obtained. Complete aneurysm closure without neck remnant or regrowth was confirmed in 137 (96%) aneurysms. In 4 (3%) cases, neck remnants were detected (2 on the anterior communicating artery [AComA] and 2 on the middle cerebral artery [MCA]). A total clip slippage from the aneurysm dome was revealed in 1 case. One case of aneurysm re-rupture was noted, 11 years after clipping. The rebleeding was caused by AComA aneurysm regrowth. Among these 6 patients with unsatisfactory clipping, 2 required further treatment and 4 remain under observation. Nineteen 'de novo' aneurysms in other locations were found in 14 (12%) patients. Summing up all of the pathological findings in the study group, there were 18 (15%) patients who needed further management including close surveillance or re-treatment.
Computed tomography angiography is a simple and reliable method of aneurysm clipping evaluation. The long- term follow-up CTA confirmed the permanent and complete obliteration of 96% of the aneurysms. The rate of unsatisfactory aneurysm closure was 4%, but only 1.4% needed re-treatment during a mean follow-up of 6 years. The annual risk of aneurysm re-rupture was 0.1%.
本回顾性研究旨在评估计算机断层血管造影（CTA）在长期随访中对夹闭动脉瘤的效果。
对 119 例夹闭 143 个动脉瘤的患者进行 CTA 检查。使用 GE Lightspeed PRO16 扫描仪在夹闭后 3 至 11 年（平均 6 年）进行检查。
除 1 例外，所有患者均获得了适合评估夹闭部位周围动脉的高质量 CTA 图像。137 例（96%）动脉瘤完全闭塞，无颈部残留或复发。4 例（3%）发现颈部残留（前交通动脉[ACoMA]上 2 例，大脑中动脉[MCA]上 2 例）。1 例完全夹闭从动脉瘤瘤顶滑脱。1 例患者在夹闭 11 年后出现动脉瘤再破裂。再出血是由 ACoMA 动脉瘤复发引起的。在这 6 例夹闭不满意的患者中，2 例需要进一步治疗，4 例仍在观察中。14 例（12%）患者在其他部位发现 19 个“新”动脉瘤。在研究组中，所有的病理发现加起来，有 18 例（15%）患者需要进一步治疗，包括密切监测或再治疗。
CTA 是一种评估动脉瘤夹闭的简单可靠方法。长期随访 CTA 证实 96%的动脉瘤永久性完全闭塞。夹闭不满意的发生率为 4%，但在平均 6 年的随访中，只有 1.4%需要再次治疗。动脉瘤再破裂的年风险为 0.1%。
