Chung Eui Jin, Shin Yong Sam, Lee Cheol Hyoun, Song Ji Hye, Park Jung Eon
Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea.
Acta Neurochir (Wien). 2014 Jul;156(7):1289-95. doi: 10.1007/s00701-014-2104-y. Epub 2014 May 8.
Endovascular treatment of intracranial aneurysms can be technically challenging in cases of wide necks or unfavorable dome-to-neck ratio. Coils deployed without supporting devices may herniate from the aneurysm sac into the parent artery, causing thromboembolic complications or vessel occlusion. Therefore, alternative strategies for managing wide-necked aneurysms have been introduced such as stent-assisted coil embolization (SAC), balloon-assisted coil embolization (BAC), and double-catheter coil embolization (DCC).
SAC, BAC, or DCC were used to treat 201 patients with 207 wide-neck aneurysms between 2008 and 2013. Initial occlusion rates, recanalization rates, and periprocedural complications were retrospectively evaluated. The mean follow-up periods for SAC, BAC, and DCC were 16.2 months, 11.6 months, and 14.3 months, respectively.
Clinical and anatomical analyses were conducted in 201 patients with 207 anuerysms. Complete occlusion rates of SAC, DCC, and BAC were 63.8 %, 46.7 %, and 63.2 %, respectively, and incomplete occlusion rates were 13.4 %, 15.5 %, 10.5 %, respectively (p value = 0.798). No rebleeding or hemorrhage occurred after coil embolization. Recanalization rates did not differ among the SAC, DCC, and BAC groups (7.1 % vs. 11.1 % vs. 7.9 %, p value = 0.696). Statistically insignificant results were observed in the rate of periprocedural complications among SAC, DCC, and BAC (11.0 % vs. 13.3 % vs. 15.8 %, p value = 0.578).
There were no significant differences in the recurrence rate and periprocedural complication rate, and no rebleeding or aneurysmal rupture after treatment. Sufficient occlusion rates were achieved with SAC, DCC, and BAC. Notably, DCC does not require the use of antiplatelet agents and achieves coil stability without compromising the parent artery or major branch. Thus, we believe that the double-catheter technique was found to be a feasible and safe treatment modality for branching wide-neck aneurysms.
在宽颈或瘤颈比不利的情况下，颅内动脉瘤的血管内治疗在技术上可能具有挑战性。在没有支撑装置的情况下部署的弹簧圈可能会从动脉瘤囊中疝入载瘤动脉，导致血栓栓塞并发症或血管闭塞。因此，已引入了其他治疗宽颈动脉瘤的策略，如支架辅助弹簧圈栓塞术（SAC）、球囊辅助弹簧圈栓塞术（BAC）和双导管弹簧圈栓塞术（DCC）。
2008年至2013年间，采用SAC、BAC或DCC治疗了201例患有207个宽颈动脉瘤的患者。回顾性评估初始闭塞率、再通率和围手术期并发症。SAC、BAC和DCC的平均随访期分别为16.2个月、11.6个月和14.3个月。
对201例患有207个动脉瘤的患者进行了临床和解剖学分析。SAC、DCC和BAC的完全闭塞率分别为63.8%、46.7%和63.2%，不完全闭塞率分别为13.4%、15.5%、10.5%（p值 = 0.798）。弹簧圈栓塞术后未发生再出血或出血。SAC、DCC和BAC组之间的再通率无差异（7.1%对11.1%对7.9%，p值 = 0.696）。在SAC、DCC和BAC的围手术期并发症发生率方面观察到无统计学意义的结果（11.0%对13.3%对15.8%，p值 = 0.578）。
复发率和围手术期并发症发生率无显著差异，治疗后无再出血或动脉瘤破裂。SAC、DCC和BAC均实现了足够的闭塞率。值得注意的是，DCC不需要使用抗血小板药物，并且在不损害载瘤动脉或主要分支的情况下实现了弹簧圈的稳定性。因此，我们认为双导管技术是治疗分支宽颈动脉瘤的一种可行且安全的治疗方式。
