Borggrefe Jan, Behme Daniel, Mpotsaris Anastasios, Weber Werner
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
World Neurosurg. 2016 Jul;91:483-9. doi: 10.1016/j.wneu.2016.04.091. Epub 2016 May 3.
We investigated the complication rates of balloon-assisted coil embolization of ruptured and unruptured cerebral aneurysms dependent on their morphologic characteristics in angiography.
The study was a single-center retrospective analysis of all consecutive endovascular balloon-assisted coiling interventions performed between April 2008 and December 2013. Data were extracted from a prospective database on an intention-to-treat basis. We described the clinical (Hunt & Hess score, modified Rankin scale) and technical results (Raymond Roy aneurysm occlusion scale) and analyzed the rate of periprocedural complications with regard to aneurysm subgroups of bifurcation aneurysms versus sidewall aneurysms.
There were 116 interventions performed on 108 patients (mean age: 51.7 ± 11.1 years), with 70/116 emergency procedures (60%), 36/116 elective procedures (31%), and 10/116 elective procedures on recurrent aneurysms (9%). The balloon was used in 108/116 cases (93%). Among the cases, 76/116 were bifurcation aneurysms and 40/116 were sidewall aneurysms. Periprocedural complications, such as rerupture, thrombus formation, distal embolism, coil-loop protrusion, and coil migration, occurred in 26/116 cases (22%). Complications occurred significantly more often in ruptured than unruptured bifurcation aneurysms (23 vs. 3 events, P < 0.05). There was a significantly higher rate of complications in bifurcation aneurysms compared with sidewall aneurysms (17% vs. 3%, P = 0.03). Six periprocedural complications were associated with a permanent neurologic deficit (6% of cases), all of which occurred in the subgroup of acutely ruptured aneurysms.
The risk of periprocedural complications in balloon-assisted coil embolization of ruptured and unruptured cerebral aneurysms is linked to the morphologic presentation of the aneurysm; the complication rate was significantly higher in bifurcation aneurysms.
我们研究了根据破裂和未破裂脑动脉瘤在血管造影中的形态特征进行球囊辅助弹簧圈栓塞术的并发症发生率。
本研究是对2008年4月至2013年12月期间所有连续进行的血管内球囊辅助弹簧圈栓塞干预进行的单中心回顾性分析。数据从一个前瞻性数据库中按意向性治疗原则提取。我们描述了临床结果（Hunt & Hess评分、改良Rankin量表）和技术结果（Raymond Roy动脉瘤闭塞量表），并分析了分叉动脉瘤与侧壁动脉瘤亚组的围手术期并发症发生率。
对108例患者进行了116次干预（平均年龄：51.7±11.1岁），其中急诊手术70/116例（60%），择期手术36/116例（31%），复发性动脉瘤择期手术10/116例（9%）。108/116例（93%）使用了球囊。其中，76/116例为分叉动脉瘤，40/116例为侧壁动脉瘤。26/116例（22%）发生了围手术期并发症，如再破裂、血栓形成、远端栓塞、弹簧圈环突出和弹簧圈移位。破裂的分叉动脉瘤比未破裂的分叉动脉瘤并发症发生率显著更高（23例对3例，P<0.05）。与侧壁动脉瘤相比，分叉动脉瘤的并发症发生率显著更高（17%对3%，P = 0.03）。6例围手术期并发症与永久性神经功能缺损相关（占病例的6%），所有这些均发生在急性破裂动脉瘤亚组中。
破裂和未破裂脑动脉瘤球囊辅助弹簧圈栓塞术的围手术期并发症风险与动脉瘤的形态表现有关；分叉动脉瘤的并发症发生率显著更高。
