Bechan R S, Majoie C B, Sprengers M E, Peluso J P, Sluzewski M, van Rooij W J
From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands.
Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands.
AJNR Am J Neuroradiol. 2016 Jan;37(1):125-9. doi: 10.3174/ajnr.A4487. Epub 2015 Aug 20.
At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort.
Between January 1995 and January 2015, occlusion of the ICA was considered in 146 patients with large or giant ICA aneurysms. Ninety-six patients (66%) passed the angiographic test occlusion, and, in 88 of these 96 patients (92%), the ICA was permanently occluded. In 11 of 88 patients with angiographic tolerance, ICA occlusion was performed with the patient under general anesthesia without clinical testing.
There was 1 hypoperfusion infarction after hypovolemic shock from a large retroperitoneal hematoma (complication rate 1.1% [95% CI, 1%-6.8%]). The mean imaging and clinical follow-up was 35 months (median 18 months; range, 3-180 months). On the latest MR imaging, 87 of 88 aneurysms (99%) were completely occluded and 61 of 80 aneurysms (76%) were decreased in size or completely obliterated. Of 62 patients who presented with cranial nerve dysfunction by mass effect of the aneurysm, 30 (48%) were cured, 25 (40%) improved, 6 (10%) were unchanged, and 1 patient (2%) was hemiplegic after a complication.
ICA occlusion for large and giant aneurysms after angiographic test occlusion was safe and effective. Two-thirds of eligible patients passed the angiographic test. Most aneurysms shrunk, and most cranial nerve dysfunctions were cured or improved.
在我们机构，大型或巨大型颈内动脉（ICA）动脉瘤患者首选血管内ICA球囊闭塞治疗。仅对不能耐受永久性ICA闭塞的患者提供替代治疗或保守治疗。在这项观察性研究中，我们报告了一个大型单中心患者队列中ICA闭塞治疗动脉瘤的临床和影像学结果。
1995年1月至2015年1月期间，146例大型或巨大型ICA动脉瘤患者接受了ICA闭塞治疗的评估。96例患者（66%）通过了血管造影试验性闭塞，其中88例（92%）患者的ICA被永久性闭塞。在88例血管造影耐受的患者中，有11例在全身麻醉下未进行临床测试就进行了ICA闭塞。
1例患者因巨大腹膜后血肿导致低血容量性休克后发生灌注不足性梗死（并发症发生率1.1%[95%CI，1%-6.8%]）。平均影像学和临床随访时间为35个月（中位数18个月；范围3-180个月）。在最新的磁共振成像（MR）上，88个动脉瘤中的87个（99%）完全闭塞，80个动脉瘤中的61个（76%）体积缩小或完全消失。在62例因动脉瘤占位效应出现颅神经功能障碍的患者中，30例（48%）治愈，25例（40%）改善，6例（10%）无变化，1例患者（2%）在发生并发症后偏瘫。
血管造影试验性闭塞后对大型和巨大型动脉瘤进行ICA闭塞是安全有效的。三分之二符合条件的患者通过了血管造影试验。大多数动脉瘤缩小，大多数颅神经功能障碍得到治愈或改善。
