Jeon P, Kim B M, Kim D J, Kim D I, Suh S H
From the Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology (B.M.K., D.J.K., D.I.K.), Severance Hospital.
AJNR Am J Neuroradiol. 2014 Jun;35(6):1170-3. doi: 10.3174/ajnr.A3821. Epub 2013 Dec 26.
Although multiple intracranial aneurysms are frequent, determining treatment strategy and methods for them is often complicated. The aim of this study was to evaluate the safety and effectiveness of 1-stage coiling for multiple intracranial aneurysms.
All patients who underwent 1-stage coiling for ≥2 aneurysms were identified from a prospectively registered neurointerventional data base during 10 years. The patient characteristics and clinical and angiographic outcomes at discharge and follow-up were retrospectively evaluated.
One hundred sixty-seven patients (male/female ratio, 30:137; mean age, 58 years) with multiple aneurysms (418 aneurysms; mean, 2.5 aneurysms/patient) underwent attempted 1-stage coiling for ≥2 aneurysms (359 aneurysms; mean, 2.1 aneurysms/patient). In 131 patients (78.4%), all detected aneurysms were treated with coiling only. Treatment-related morbidity and mortality at discharge were 1.8% and 0.6% per patient, respectively. Of the 132 patients without subarachnoid hemorrhage, 129 (97.7%) had favorable outcomes (mRS 0-2) at discharge; of the 35 patients with SAH, 27 (77.1%) had favorable outcomes at discharge. Of the 162 patients (97%) for whom clinical follow-up was available (mean, 35.8 months), 154 patients (95.1%) had favorable outcomes. Immediate posttreatment angiography showed complete occlusion in 186 (51.8%) aneurysms, neck remnants in 134 (37.3%), sac remnants in 33 (9.2%), and failure in 6 (1.7%). Of the 262 (73.9%) aneurysms that underwent follow-up imaging (mean, 24.8 months), 244 (93.1%) showed a stable or improved state, with 12 (4.6%) minor and 6 (2.3%) major recurrences.
One-stage coiling of multiple aneurysms seems to be safe and effective, with low morbidity and mortality.
尽管颅内多发动脉瘤很常见，但确定其治疗策略和方法往往很复杂。本研究的目的是评估颅内多发动脉瘤一期弹簧圈栓塞术的安全性和有效性。
从一个前瞻性登记的神经介入数据库中识别出在10年间接受≥2个动脉瘤一期弹簧圈栓塞术的所有患者。回顾性评估患者的特征以及出院时和随访时的临床及血管造影结果。
167例多发动脉瘤患者（男/女比例为30:137；平均年龄58岁）（共418个动脉瘤；平均每位患者2.5个动脉瘤）接受了≥2个动脉瘤的一期弹簧圈栓塞术尝试（共359个动脉瘤；平均每位患者2.1个动脉瘤）。131例患者（78.4%）中，所有检测到的动脉瘤仅接受了弹簧圈栓塞治疗。出院时与治疗相关的发病率和死亡率分别为每位患者1.8%和0.6%。在132例无蛛网膜下腔出血的患者中，129例（97.7%）出院时预后良好（改良Rankin量表评分0 - 2分）；在35例有蛛网膜下腔出血的患者中，27例（77.1%）出院时预后良好。在162例（97%）有临床随访资料的患者中（平均随访35.8个月），154例（95.1%）预后良好。治疗后即刻血管造影显示186个（51.8%）动脉瘤完全闭塞，134个（37.3%）有瘤颈残留，33个（9.2%）有瘤囊残留，6个（1.7%）治疗失败。在262个（73.9%）接受随访影像学检查的动脉瘤中（平均随访24.8个月），244个（93.1%）显示状态稳定或改善，12个（4.6%）有轻微复发，6个（2.3%）有严重复发。
多发动脉瘤一期弹簧圈栓塞术似乎安全有效，发病率和死亡率较低。
