Goel Gaurav, Gupta Vipul, Chinchure Swati, Gupta Aditya, Kaur Gurmeen, Jha Ajaya N
Department of Neurointervention surgery and Neurosurgery, Institute of Neurosciences, Medanta Hospital, Gurgaon, Haryana, India.
Asian J Neurosurg. 2014 Jul-Sep;9(3):137-43. doi: 10.4103/1793-5482.142733.
The technique of coiling has evolved in the last decade with evolution in both equipment and material. The preferable treatment of intracranial aneurysms at our center is endovascular coiling. We discuss the technical and management outcomes of consecutive patients treated with this approach and compare our results with a decade old International Subarachnoid Aneurysm Trial.
Between January 2006 and November 2011, a total of 324 aneurysms in 304 consecutive patients were treated. Endovascular treatment was done in 308 aneurysms (95.0%) in 288 patients while 16 patients (5%) underwent surgical clipping. Of the 308 aneurysms treated endovascularly, 269 (87.3%) were ruptured, and 39 (12.7%) were unruptured aneurysms.
The endovascular coiling was feasible in all (99.6%) but 1 case. The immediate postoperative occlusion status was complete occlusion in 240 aneurysms (77.9%), neck remnant in 57 aneurysms (18.5%), and aneurysm remnant in 11 aneurysms (3.6%). Technical issues - with or without clinical effect-were encountered in 20 patients (6.9%). They included 18 thromboembolic events (6.2%) and intraprocedural aneurysmal rupture in 2 cases (0.7%). In "good grade" patients, H and H grade 1-3, a good outcome (modified Rankin score [mRS] 0-2) was in 87.6% patients while the bad outcome (mRS 3-5) was in 10.2% patients and mortality of 2.2%. In "bad grade" patients, H and H grade 3-5, a good outcome was in 29.2%, and bad outcome was in 41.7% patients with mortality was 29.1%. In the unruptured aneurysm group, the good outcome was seen in 97.7% and bad outcome in 2.3% with no mortality.
In the current era, the favorable results of coiling demonstrated in previous studies may be applicable to the larger proportion of patients. In our series of consecutively treated patients using latest advances, such as three-dimensional imaging and the interventional material, endovascular management as first choice was feasible in 95% of patients with good technical and management outcomes.
在过去十年中，随着设备和材料的发展，弹簧圈栓塞技术也不断演进。我们中心治疗颅内动脉瘤的首选方法是血管内弹簧圈栓塞术。我们讨论了采用这种方法连续治疗的患者的技术和治疗结果，并将我们的结果与十年前的国际蛛网膜下腔动脉瘤试验进行比较。
2006年1月至2011年11月，连续304例患者共治疗了324个动脉瘤。288例患者的308个动脉瘤（95.0%）接受了血管内治疗，16例患者（5%）接受了外科夹闭术。在308个接受血管内治疗的动脉瘤中，269个（87.3%）为破裂动脉瘤，39个（12.7%）为未破裂动脉瘤。
除1例患者外，血管内弹簧圈栓塞术在所有患者（99.6%）中均可行。术后即刻闭塞情况为：240个动脉瘤（77.9%）完全闭塞，57个动脉瘤（18.5%）颈部残留，11个动脉瘤（3.6%）瘤体残留。20例患者（6.9%）出现技术问题，无论有无临床影响。其中包括18例血栓栓塞事件（6.2%）和2例术中动脉瘤破裂（0.7%）。在H和H分级为1 - 3级的“良好分级”患者中，87.6%的患者预后良好（改良Rankin评分[mRS] 0 - 2），10.2%的患者预后不良（mRS 3 - 5），死亡率为2.2%。在H和H分级为3 - 5级的“不良分级”患者中，29.2%的患者预后良好，41.7%的患者预后不良，死亡率为29.1%。在未破裂动脉瘤组中，97.7%的患者预后良好，2.3%的患者预后不良，无死亡病例。
在当前时代，先前研究中显示的弹簧圈栓塞术的良好结果可能适用于更大比例的患者。在我们这一系列采用最新进展（如三维成像和介入材料）连续治疗的患者中，血管内治疗作为首选方法在95%的患者中可行，技术和治疗结果良好。
