Cho Y D, Ahn J H, Jung S C, Kim C H, Cho W S, Kang H-S, Kim J E, Han M H
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
Clin Neuroradiol. 2016 Sep;26(3):285-90. doi: 10.1007/s00062-014-0367-6. Epub 2014 Dec 17.
Not infrequently, intracranial aneurysms may be multifocal. However, strategies conferring open surgical access to opposite sides of the brain are limited. Given the recent advances in protection devices and coiling technique, a study of single-stage coil embolization in patients with multiple intracranial aneurysms was undertaken, assessing procedural safety and efficacy.
Data prospectively accrued between January 2010 and September 2013 were systematically reviewed, assessing clinical and morphologic outcomes of single-stage coil embolization in 172 patients with multiple aneurysms (≥ 2 aneurysms each; total, 371 aneurysms).
Internal carotid artery (n = 132) was the most common site, with progressively fewer aneurysms found elsewhere (middle cerebral artery, 103; anterior communicating artery, 41; posterior communicating artery, 38). In 26 patients, one-stage embolization of three or more aneurysms took place (25 patients with three each; 1 patient with four). Stents were applied in 109 aneurysms, and in 33 lesions, balloons were used. Occlusion was achieved in 326 aneurysms (87.9 %) through coil embolization, and attempted coiling rarely failed (3 of 371, 0.8 %). Mean procedural time was 111.5 ± 37.8 min. Although procedure-related adverse events included three instances of treatment failure, asymptomatic thrombi in four patients, and aneurysmal leakage in one patient, procedural morbidity was low (1 of 172, 0.6 %), and no procedure-related deaths occurred. Postembolization follow-up of 303 aneurysms at > 6 months (mean, 15.4 ± 9.8 months) showed complete occlusion in the vast majority (275 of 303, 90.8 %), with comparatively fewer instances of minor (19 of 303, 6.3 %) and major (9 of 303, 3.0 %) recanalization. Four patients experienced delayed cerebral infarction, but only one suffered permanent neurologic deficit (Glasgow outcome scale 4).
Single-stage coil embolization of multiple unruptured intracranial aneurysms is technically feasible. The time required for such procedures and the rate of complications observed seem acceptable.
颅内动脉瘤常常是多发的。然而，能实现双侧大脑开放手术入路的策略有限。鉴于保护装置和栓塞技术的最新进展，我们开展了一项针对多发颅内动脉瘤患者的单阶段弹簧圈栓塞研究，评估手术安全性和有效性。
系统回顾2010年1月至2013年9月前瞻性收集的数据，评估172例多发动脉瘤患者（每人≥2个动脉瘤；共371个动脉瘤）单阶段弹簧圈栓塞的临床和形态学结果。
颈内动脉（n = 132）是最常见的部位，其他部位发现的动脉瘤逐渐减少（大脑中动脉，103个；前交通动脉，41个；后交通动脉，38个）。26例患者进行了三个或更多动脉瘤的一期栓塞（25例患者每人3个；1例患者4个）。109个动脉瘤应用了支架，33个病变使用了球囊。通过弹簧圈栓塞，326个动脉瘤（87.9%）实现了闭塞，尝试栓塞很少失败（371个中的3个，0.8%）。平均手术时间为111.5±37.8分钟。虽然与手术相关的不良事件包括3例治疗失败、4例患者出现无症状血栓以及1例患者动脉瘤渗漏，但手术并发症发生率较低（172例中的1例，0.6%），且未发生与手术相关的死亡。对303个动脉瘤进行>6个月（平均15.4±9.8个月）的栓塞后随访，绝大多数（303个中的275个，90.8%）实现了完全闭塞，轻度（303个中的19个，6.3%）和重度（303个中的9个，3.0%）再通的情况相对较少。4例患者发生了延迟性脑梗死，但只有1例出现永久性神经功能缺损（格拉斯哥预后量表4级）。
多发未破裂颅内动脉瘤的单阶段弹簧圈栓塞在技术上是可行的。此类手术所需时间和观察到的并发症发生率似乎是可以接受的。
