Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Cerebrovasc Dis. 2013;35(3):235-40. doi: 10.1159/000347078. Epub 2013 Mar 19.
Endovascular treatment of aneurysms has been introduced as a less invasive method for decreasing the rate of aneurysm rerupture and subsequent subarachnoid hemorrhage. The outcome and complication rate for endovascular treatment of very small (≤3 mm) and very large (15-25 mm) intracranial aneurysms has been controversial. Here we report our experience with endovascular coiling of very small and very large ruptured aneurysms of the anterior cerebral circulation.
Patients were included in the study if the maximum dimension of the intracranial ruptured aneurysm was reported to be ≤3 mm or 15-25 mm and if the aneurysm was within the anterior cerebral circulation. The largest dimension was calculated using CT angiography and was confirmed by digital subtraction angiography. Endovascular coiling was performed using Guglielmi detachable coils. All patients underwent follow-up contrast MR angiography every 6 months.
A total of 40 cases (18 females and 22 males) were included in this single-center study. Twenty-one very small and 19 very large ruptured aneurysms were analyzed. Preprocedural Hunt and Hess grades were determined. Endovascular coiling was performed successfully in most cases (97.5%), with unsuccessful coiling in 1 patient with a very small ruptured aneurysm. In the very small aneurysm group, the most common location was the anterior communicating artery and, in the large aneurysm group, the most common location was the middle cerebral artery (MCA) bifurcation. The mean follow-up time was 15.08 months (range: 6-30 months). The 6th month modified Rankin scale (mRS) values for very small aneurysm cases were 0 (no symptoms at all) in 16 cases (76.2%) and 1 (no significant disability despite symptoms) in 5 cases (23.80%). For the very large aneurysm cases, the mRS values were 1 in 2 cases (10.5%), 2 in 7 cases (36.8%), 3 in 6 cases (31.6%), 4 in 3 cases (15.8%) and 6 in 1 case (died due to vasospasm 72 h later; 5.2%). The immediate complications that were observed were MCA branch occlusion in 1 very small aneurysm patient and early vasospasms in 3 very large aneurysm patients. The late complication that was observed was recanalization in 1 very small aneurysm case (1/21, 4.76%) and in 5 very large aneurysm cases (5/18, 27.77%).
Endovascular treatment of very small aneurysms is an effective method of treatment with acceptable immediate and long-term outcomes. Immediate and long-term complications were more prevalent in very large ruptured aneurysms.
血管内治疗已被引入作为降低动脉瘤再破裂和随后蛛网膜下腔出血发生率的一种较微创方法。对于非常小（≤3mm）和非常大（15-25mm）颅内动脉瘤的血管内治疗的结果和并发症发生率一直存在争议。在此，我们报告我们在治疗前循环破裂的非常小和非常大的动脉瘤方面的经验。
如果颅内破裂动脉瘤的最大直径报告为≤3mm 或 15-25mm 且动脉瘤位于前循环内，则将患者纳入研究。最大直径通过 CT 血管造影计算，并通过数字减影血管造影确认。使用可解脱的弹簧圈进行血管内线圈填塞。所有患者每 6 个月接受一次对比磁共振血管造影随访。
这项单中心研究共纳入了 40 例患者（18 名女性和 22 名男性）。分析了 21 例非常小的和 19 例非常大的破裂动脉瘤。术前 Hunt 和 Hess 分级确定。大多数情况下（97.5%）成功进行了血管内线圈填塞，1 例非常小的破裂动脉瘤患者填塞失败。在非常小的动脉瘤组中，最常见的部位是前交通动脉，而在大动脉瘤组中，最常见的部位是大脑中动脉（MCA）分叉处。平均随访时间为 15.08 个月（6-30 个月）。非常小的动脉瘤组在第 6 个月的改良 Rankin 量表（mRS）评分中，0 分（无症状）为 16 例（76.2%），1 分（有症状但无明显残疾）为 5 例（23.80%）。对于非常大的动脉瘤病例，mRS 值为 2 分（2 例，10.5%）、3 分（7 例，36.8%）、4 分（6 例，31.6%）、5 分（3 例，15.8%）和 6 分（1 例，死于 72 小时后的血管痉挛；5.2%）。观察到的即时并发症为 1 例非常小的动脉瘤患者 MCA 分支闭塞和 3 例非常大的动脉瘤患者早期血管痉挛。观察到的迟发性并发症为 1 例非常小的动脉瘤病例（1/21，4.76%）和 5 例非常大的动脉瘤病例（5/18，27.77%）的再通。
血管内治疗非常小的动脉瘤是一种有效的治疗方法，具有可接受的即时和长期结果。即时和长期并发症在非常大的破裂动脉瘤中更为常见。
