Gross Bradley A, Albuquerque Felipe C, Moon Karam, Ducruet Andrew F, McDougall Cameron G
Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
J Neurointerv Surg. 2017 Feb;9(2):169-172. doi: 10.1136/neurintsurg-2016-012625. Epub 2016 Aug 8.
BACKGROUND/OBJECTIVE: The optimal management of residual or recurrent clipped aneurysms is infrequently addressed in the literature.
We reviewed our endovascular database from January 1998 to May 2016 to identify patients with clipped aneurysms undergoing subsequent endovascular treatment, evaluating treatment approach, and clinical and angiographic outcomes.
60 patients underwent endovascular treatment of residual/recurrent clipped aneurysms; 7 rebled prior to endovascular therapy. Treatment was via coiling alone (n=25, 42%), stent assisted coiling (n=15, 25%), balloon assisted coiling (n=8, 13%), flow diversion (n=8, 13%), stenting alone (n=3, 5%), or flow diversion with coiling (n=1, 2%). The procedural permanent neurological morbidity and mortality rates were 3% and 2%, respectively. Over a clinical follow-up of 253.4 patient years (median 3.9 years), there was one rebleed in a patient who had declined further treatment. For 43 patients with at least 1 month of digital subtraction angiographic follow-up (median 3.4 years), complete aneurysm occlusion was seen in 79% of cases. Neck remnants were observed in 14%, and stable small dome remnants were observed in 7% of cases. In a subgroup of 18 patients with 'clip induced' narrow neck aneurysms, all domes were initially coil occluded (Raymond 1 or 2); there was no permanent procedural morbidity and no aneurysms required retreatment or recanalized over a median follow-up of 3.9 years.
Endovascular treatment of residual or recurrent clipped aneurysms is an excellent treatment approach in well selected patients; 'clip induced' narrow neck aneurysms fare particularly well after treatment both angiographically and clinically.
背景/目的：文献中很少涉及残余或复发性夹闭动脉瘤的最佳治疗方法。
我们回顾了1998年1月至2016年5月期间的血管内治疗数据库，以确定接受后续血管内治疗的夹闭动脉瘤患者，评估治疗方法以及临床和血管造影结果。
60例患者接受了残余/复发性夹闭动脉瘤的血管内治疗；7例在血管内治疗前再次出血。治疗方式包括单纯弹簧圈栓塞（n = 25，42%）、支架辅助弹簧圈栓塞（n = 15，25%）、球囊辅助弹簧圈栓塞（n = 8，13%）、血流导向（n = 8，13%）、单纯支架置入（n = 3，5%）或血流导向联合弹簧圈栓塞（n = 1，2%）。手术永久性神经功能缺损发生率和死亡率分别为3%和2%。在253.4患者年的临床随访期（中位随访时间3.9年）内，1例拒绝进一步治疗的患者再次出血。43例患者接受了至少1个月的数字减影血管造影随访（中位随访时间3.4年），79%的病例动脉瘤完全闭塞。14%的病例观察到瘤颈残余，7%的病例观察到稳定的小瘤顶残余。在18例“夹闭导致”的窄颈动脉瘤亚组中，所有瘤顶最初均通过弹簧圈闭塞（Raymond 1级或2级）；在中位随访3.9年期间，无永久性手术并发症，无需对动脉瘤进行再次治疗或再通。
对于精心挑选的患者，血管内治疗残余或复发性夹闭动脉瘤是一种极佳的治疗方法；“夹闭导致”的窄颈动脉瘤在血管造影和临床治疗后效果特别好。
