Meguro Toshinari, Kuwahara Ken, Tomita Yusuke, Okuma Yu, Tanabe Tomoyuki, Muraoka Kenichiro, Terada Kinya, Hirotsune Nobuyuki, Nishino Shigeki
Department of Neurological Surgery, Hiroshima City Hospital.
No Shinkei Geka. 2014 Oct;42(10):917-23. doi: 10.11477/mf.1436200005.
Ischemic stroke of the anterior choroidal artery(AChA)is the most common and serious complication after AChA aneurysm treatment. The purpose of this study was to retrospectively evaluate and compare the treatment-related ischemic complications after surgical clipping and endovascular coiling of AChA aneurysms.
Between June 2006 and March 2013, 32 patients with 34 AChA aneurysms were treated in our hospital by surgical clipping or endovascular coiling. There were 12 cases of ruptured aneurysms, seven cases of unruptured aneurysms, and 15 cases of incidentally identified unruptured aneurysms. Of the 34 aneurysms, 19 were managed with surgical clipping and 15 were managed with endovascular coiling. No rebleeding or retreatment occurred in any case during 4-84 months(median, 25 months)of follow-up, and no significant differences in clinical outcome were seen between clipping and coiling cases. Although there were four cases(11.8%;surgical clipping in three;endovascular coiling in one)of postoperative AChA infarction, we believe that we preserved the blood flow of the AChA during the procedure. The occurrence of subarachnoid hemorrhage and premature rupture during surgical clipping were significantly correlated with AChA infarction.
脉络膜前动脉(AChA)缺血性卒中是AChA动脉瘤治疗后最常见且最严重的并发症。本研究的目的是回顾性评估和比较AChA动脉瘤手术夹闭和血管内栓塞治疗后与治疗相关的缺血性并发症。
2006年6月至2013年3月期间,我院对32例患者的34个AChA动脉瘤进行了手术夹闭或血管内栓塞治疗。其中破裂动脉瘤12例,未破裂动脉瘤7例,偶然发现的未破裂动脉瘤15例。34个动脉瘤中,19个采用手术夹闭治疗,15个采用血管内栓塞治疗。在4至84个月(中位数为25个月)的随访期间,无一例发生再出血或再次治疗,夹闭组和栓塞组的临床结局无显著差异。虽然有4例(11.8%;手术夹闭3例,血管内栓塞1例)术后发生AChA梗死,但我们认为我们在手术过程中保留了AChA的血流。手术夹闭期间蛛网膜下腔出血和过早破裂的发生与AChA梗死显著相关。