Chalouhi N, Tjoumakaris S, Gonzalez L F, Dumont A S, Starke R M, Hasan D, Wu C, Singhal S, Moukarzel L A, Rosenwasser R, Jabbour P
From the Department of Neurosurgery (N.C., S.T., L.F.G., A.S.D., R.M.S., C.W., S.S., L.A.M., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
AJNR Am J Neuroradiol. 2014 Mar;35(3):546-52. doi: 10.3174/ajnr.A3696. Epub 2013 Aug 14.
Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome.
A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling.
Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome.
Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
大型和巨大型颅内动脉瘤越来越多地采用血管内技术进行治疗。本研究的目的是回顾性分析大型和巨大型动脉瘤（≥10毫米）栓塞治疗的并发症和长期结果，并确定预后的预测因素。
2004年至2011年间，我院共对334例大型或巨大型动脉瘤（≥10毫米）进行了栓塞治疗。回顾病历和影像学检查以确定基线特征、手术并发症以及临床/血管造影结果。动脉瘤平均大小为15毫米。225例动脉瘤采用传统栓塞治疗；88例采用支架辅助栓塞治疗；14例采用载瘤动脉闭塞术；7例采用球囊辅助栓塞治疗。
10.5%的患者出现并发症，1例死亡（0.3%）。动脉瘤位置和破裂动脉瘤是并发症的预测因素。平均25.4个月时，84%的患者接受了血管造影随访。再通率和再次治疗率分别为39%和33%。较大的动脉瘤大小、随访时间延长、传统栓塞治疗以及动脉瘤位置是复发和再次治疗的预测因素。年再出血率为1.9%。较大的动脉瘤大小、随访时间延长以及动脉瘤位置是新发或复发性出血的预测因素。92%的患者预后良好。较大的动脉瘤大小、较差的Hunt和Hess分级以及新发或复发性出血提示预后不良。
大型和巨大型动脉瘤栓塞治疗具有合理的安全性和良好的临床结果，但动脉瘤再通仍然非常常见。与传统栓塞治疗相比，支架辅助栓塞治疗的复发率、再次治疗率以及新发或复发性出血率更低，且无额外的发病率。动脉瘤大小是再通、再次治疗、新发或复发性出血以及预后不良的主要决定因素。
