Jeon Jin Pyeong, Cho Young Dae, Rhim Jong Kook, Yoo Dong Hyun, Kang Hyun-Seung, Kim Jeong Eun, Cho Won-Sang, Han Moon Hee
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Eur Radiol. 2016 Oct;26(10):3319-26. doi: 10.1007/s00330-015-4176-3. Epub 2016 Jan 8.
To estimate long-term durability in coiled aneurysms completely occluded at 6-month follow-up imaging, focusing on late recanalization rate and the risk factors involved.
A cohort of 620 patients harbouring 698 completely occluded coiled aneurysms at 6-month follow-up was subjected to extended monitoring (mean, 24.5 ± 7.9 months). Cumulative recanalization rate and related risk factors were analysed using Cox proportional hazards regression and Kaplan-Meier product-limit estimator.
Forty-three aneurysms (6.2 %) occluded completely at 6-months displayed recanalization (3.02 % per aneurysm-year) during continued surveillance (1425.5 aneurysm-years), with 26 (60.5 %) surfacing in another 6 months, 15 (34.9 %) within 18 months and 2 (4.6 %) within 30 months. Cumulative survival rates without recanalization were significantly lower in subjects with aneurysms >7 mm (p = 0.014), with bifurcation aneurysms (p = 0.009) and with subarachnoid haemorrhage (SAH) at presentation (p < 0.001). Multivariate analysis indicated that aneurysms >7 mm (HR = 2.37, p = 0.02) and bifurcation aneurysms (HR = 2.70, p = 0.03) were significant factors in late recanalization, whereas a link with SAH at presentation was marginal (HR = 1.92, p = 0.06) and stent placement fell short of statistical significance (HR = 0.47; p = 0.12).
Most (93.8 %) coiled aneurysms showing complete occlusion at 6 months post-procedure were stable in long-term monitoring. However, aneurysms >7 mm and bifurcation aneurysms were predisposed to late recanalization.
• Most coiled aneurysms showing complete occlusion at 6 months were stable. • Forty-three aneurysms (6.2 %) occluded completely at 6-month follow-up displayed late recanalization. • Late recanalization rate was 3.02 % per aneurysm-year during follow-up of 1425.5 aneurysm-years. • Aneurysms over 7 mm and bifurcation aneurysms were predisposed to late recanalization.
评估在6个月随访影像中完全闭塞的盘绕型动脉瘤的长期耐久性，重点关注晚期再通率及相关危险因素。
对620例患者的698个在6个月随访时完全闭塞的盘绕型动脉瘤进行延长监测（平均24.5±7.9个月）。使用Cox比例风险回归和Kaplan-Meier乘积限估计器分析累积再通率及相关危险因素。
在6个月时完全闭塞的43个动脉瘤（6.2%）在持续监测期间（1425.5个动脉瘤年）出现再通（每个动脉瘤年3.02%），其中26个（60.5%）在另外6个月内出现，15个（34.9%）在18个月内出现，2个（4.6%）在30个月内出现。动脉瘤>7mm的患者（p = 0.014）、分叉部动脉瘤患者（p = 0.009）以及就诊时发生蛛网膜下腔出血（SAH）的患者（p < 0.001），无再通的累积生存率显著较低。多因素分析表明，动脉瘤>7mm（HR = 2.37，p = 0.02）和分叉部动脉瘤（HR = 2.70，p = 0.03）是晚期再通的重要因素，而与就诊时SAH的关联较弱（HR = 1.92，p = 0.06），支架置入未达到统计学意义（HR = 0.47；p = 0.12）。
大多数（93.8%）在术后6个月显示完全闭塞的盘绕型动脉瘤在长期监测中是稳定的。然而，动脉瘤>7mm和分叉部动脉瘤易发生晚期再通。
• 大多数在6个月时显示完全闭塞的盘绕型动脉瘤是稳定的。• 43个在6个月随访时完全闭塞的动脉瘤（6.2%）出现晚期再通。• 在1425.5个动脉瘤年的随访期间，晚期再通率为每个动脉瘤年3.02%。• 动脉瘤直径超过7mm和分叉部动脉瘤易发生晚期再通。
