Yamazaki Tomosato, Sonobe Makoto, Kato Noriyuki, Kasuya Hiromichi, Ikeda Go, Nakamura Kazuhiro, Ito Yoshiro, Tsuruta Wataro, Nakai Yasunobu, Matsumura Akira
Department of Neurosurgery, Mito Medical Center, Japan.
Neurol Med Chir (Tokyo). 2013;53(6):409-17. doi: 10.2176/nmc.53.409.
We apply endovascular coiling as the first treatment option for ruptured pericallosal artery aneurysms. We conducted a retrospective analysis of the clinical and radiological outcomes of this treatment strategy and morphological factors associated with the success of endovascular coiling, to assess the safety and feasibility of our management strategy. From January 2003 to January 2012, we attempted endovascular coiling as the first-intention treatment for 30 consecutive patients with ruptured pericallosal artery aneurysms including those with intracerebral hematoma. Twenty-seven cases of ruptured pericallosal artery aneurysms were successfully embolized with coiling whereas three failures required surgery. Four patients experienced periprocedural complications including thromboembolic event in two and hematoma enlargement after coiling in two. A maximum aneurysm diameter of <3 mm was most strongly associated with failure of endovascular coiling. Of the 27 coil-treated aneurysms, immediate angiographic results showed complete aneurysm occlusion in 19 cases, neck remnant in 6, and residual aneurysm in 2. One patient had a major aneurysm recurrence that was uneventfully reembolized. Sixteen of our 30 patients had good outcomes (modified Rankin scale [mRS] 0-2), 7 had moderate disability (mRS 3), and 4 had severe disability (mRS 4-5) at 3 months after treatment. The management strategy for coiling as the first-intention treatment for ruptured pericallosal artery aneurysms has the potential to become an acceptable alternative to surgical clipping for selected cases, although a larger study population and longer follow-up periods are needed before definitive conclusions can be drawn.
我们将血管内栓塞术作为胼周动脉破裂动脉瘤的首选治疗方法。我们对该治疗策略的临床和影像学结果以及与血管内栓塞术成功相关的形态学因素进行了回顾性分析，以评估我们治疗策略的安全性和可行性。2003年1月至2012年1月，我们对30例连续的胼周动脉破裂动脉瘤患者（包括伴有脑内血肿的患者）首次尝试采用血管内栓塞术治疗。27例胼周动脉破裂动脉瘤患者通过栓塞成功治愈，3例失败后需进行手术。4例患者出现围手术期并发症，其中2例发生血栓栓塞事件，2例在栓塞后出现血肿扩大。最大动脉瘤直径<3 mm与血管内栓塞术失败的相关性最强。在27例接受栓塞治疗的动脉瘤中，即时血管造影结果显示19例动脉瘤完全闭塞，6例有颈部残留，2例有残余动脉瘤。1例患者出现动脉瘤复发，再次栓塞后情况平稳。30例患者中有16例在治疗后3个月预后良好（改良Rankin量表[mRS] 0 - 2），7例有中度残疾（mRS 3），4例有重度残疾（mRS 至4 - 5）。对于胼周动脉破裂动脉瘤，将栓塞术作为首选治疗方法的策略有可能成为某些特定病例中可接受的手术夹闭替代方案，不过在得出明确结论之前，还需要更大的研究人群和更长的随访期。
