Hahnemann M L, Ringelstein A, Sandalcioglu I E, Goericke S, Moenninghoff C, Wanke I, Forsting M, Sure U, Schlamann M
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, NRW, Germany.
Department of Neurosurgery, University Hospital Essen, Essen, NRW, Germany.
J Neurointerv Surg. 2014 Jul;6(6):461-5. doi: 10.1136/neurintsurg-2013-010820. Epub 2013 Aug 8.
New ischemic brain lesions are common findings after cerebral diagnostic angiography and endovascular therapy. Diffusion-weighted MRI (DWI) can be used for detection of these lesions. The aim of the present study was to investigate the incidence of DWI lesions after stent-assisted coiling and the evaluation of possible risk factors.
The study included a total of 75 consecutive patients treated with stent-assisted coiling. Post-procedural DWI of the brain was performed to detect ischemic lesions. Demographic data, aneurysm characteristics and angiographic parameters were correlated with properties of DWI lesions.
In post-procedural DWI, 48 of the 75 patients (64%) had 163 DWI lesions in a pattern consistent with embolic events. The number of patients with DWI lesions was significantly increased in older patients (≥55 years) and longer intervention times (≥120 min). The ischemic brain volume was significantly increased in older patients (≥55 years) as well as in patients who were implanted with a shorter stent (<20 mm).
Thromboembolic events are common after stent-assisted coiling with an incidence comparable to DWI studies after coiling alone. Despite several devices and low operator experience, stent-assisted coiling for intracranial aneurysms has a very low risk of permanent neurologic disability. Further studies are necessary to improve the safety of stent-assisted coiling for patients in conditions with increased risk potential (age, procedure time, stent length).
新发缺血性脑损伤是脑诊断性血管造影和血管内治疗后的常见表现。弥散加权磁共振成像（DWI）可用于检测这些损伤。本研究旨在调查支架辅助弹簧圈栓塞术后DWI损伤的发生率，并评估可能的危险因素。
本研究共纳入75例连续接受支架辅助弹簧圈栓塞治疗的患者。术后进行脑部DWI检查以检测缺血性损伤。将人口统计学数据、动脉瘤特征和血管造影参数与DWI损伤的特征进行相关性分析。
在术后DWI检查中，75例患者中有48例（64%）出现163处DWI损伤，其表现符合栓塞事件。老年患者（≥55岁）和较长的干预时间（≥120分钟）的患者中出现DWI损伤的人数显著增加。老年患者（≥55岁）以及植入较短支架（<20mm）的患者的缺血性脑体积显著增加。
支架辅助弹簧圈栓塞术后血栓栓塞事件很常见，其发生率与单纯弹簧圈栓塞术后的DWI研究结果相当。尽管使用了多种器械且术者经验不足，但颅内动脉瘤的支架辅助弹簧圈栓塞术导致永久性神经功能残疾的风险非常低。有必要进一步开展研究，以提高在具有较高潜在风险（年龄、手术时间、支架长度）的患者中进行支架辅助弹簧圈栓塞术的安全性。
