Zibold Felix, Kleine Justus F, Zimmer Claus, Poppert Holger, Boeckh-Behrens Tobias
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
J Neurointerv Surg. 2016 Oct;8(10):1016-20. doi: 10.1136/neurintsurg-2015-012079. Epub 2015 Nov 13.
Coincidental aneurysms in the target vessels of stroke patients with large vessel occlusions (LVO) may pose risks during endovascular mechanical thrombectomy (MTE), but there are almost no data on this subject. Motivated by an incident of rupture of a hidden aneurysm induced by withdrawal of a stent retriever during a MTE procedure, this study examines the prevalence of aneurysms, associated complications, and implications for treatment strategies in patients with LVO stroke.
A single-center retrospective analysis of angiographic and CT/MRI images and case records of 300 consecutive patients with LVO stroke treated with MTE was performed.
Aneurysms related to target vessels were detected in 11/300 patients, in 10/11 in the anterior circulation. In 9/11 patients the aneurysms were unknown prior to the stroke. The observed prevalence was >2-fold higher than expected for a healthy reference population. There was one complication (aneurysm rupture), as described above. In two subsequent patients with known aneurysms, MTE was conducted mainly with aspiration techniques which failed, contributing to a low recanalization rate in patients with aneurysm (45%).
The prevalence of aneurysms is relatively high in patients with LVO stroke, particularly in older, female, hypertensive patients, presumably reflecting overlapping risk factors. MTE should not be withheld from patients with LVO stroke with aneurysms, but particularly cautious approaches may be warranted. Further research in larger samples is required to obtain precise data on the prevalence and associated complication rates in MTE procedures. This is necessary to estimate the true risk and to tailor endovascular strategies in these patients.
大血管闭塞（LVO）性卒中患者的目标血管中出现巧合性动脉瘤可能在血管内机械取栓术（MTE）期间带来风险，但关于这一主题的数据几乎没有。受一例MTE手术期间因取出支架取栓器诱发隐匿性动脉瘤破裂事件的启发，本研究调查了LVO性卒中患者中动脉瘤的患病率、相关并发症以及对治疗策略的影响。
对连续300例接受MTE治疗的LVO性卒中患者的血管造影和CT/MRI图像以及病例记录进行单中心回顾性分析。
300例患者中有11例检测到与目标血管相关的动脉瘤，其中10例位于前循环。11例患者中有9例在卒中前动脉瘤未被发现。观察到的患病率比健康对照人群预期的高出两倍多。如上所述，有1例并发症（动脉瘤破裂）。在随后的2例已知动脉瘤的患者中，主要采用抽吸技术进行MTE，但未成功，导致动脉瘤患者的再通率较低（45%）。
LVO性卒中患者中动脉瘤的患病率相对较高，尤其是老年、女性、高血压患者，这可能反映了重叠的危险因素。对于有动脉瘤的LVO性卒中患者不应不进行MTE，但可能需要特别谨慎的方法。需要对更大样本进行进一步研究，以获得MTE手术中患病率和相关并发症发生率的精确数据。这对于估计真实风险并为这些患者制定血管内治疗策略是必要的。
