Jeon Jin Pyeong, Cho Young Dae, Rhim Jong Kook, Park Jeong Jin, Cho Won-Sang, Kang Hyun-Seung, Kim Jeong Eun, Hwang Gyojun, Kwon O-Ki, Han Moon Hee
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Korean J Radiol. 2016 Sep-Oct;17(5):801-10. doi: 10.3348/kjr.2016.17.5.801. Epub 2016 Aug 23.
Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs.
A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.
Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.
Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.
由于需要治疗的病例比例较低且有一系列可用的治疗选择，在椎基底动脉夹层动脉瘤（VBDAs）的情况下，支架辅助弹簧圈栓塞术（SACE）的疗效尚未得到充分证实。在此，我们展示了VBDAs患者接受SACE后的临床和影像学结果。
对2008年至2014年期间在两家机构接受SACE的47例VBDAs患者（男：女，30：17；平均年龄±标准差，53.7±12.6岁）进行回顾性评估。分析病历和放射学数据以评估SACE手术的结果。进行Cox比例风险回归分析以确定与SACE后动脉瘤再通相关的因素。
所有患者的支架辅助弹簧圈栓塞术在技术上均成功。栓塞后第1天、第2周和第2个月分别发生3例小脑梗死，但未出现其他与手术相关的并发症。SACE后立即有25个动脉瘤（53.2%）显示无造影剂填充到动脉瘤腔内。在平均20.2个月的随访期间，37个病变（78.7%）完全闭塞，而10个病变出现再通，其中5个需要额外栓塞。每个病变年的总体再通率为12.64%，再通的平均术后时间为18个月（范围3 - 36个月）。在多变量分析中，主要分支受累（风险比[HR]：7.28；p = 0.013）和残留囊腔造影剂填充的存在（HR：8.49，p = 0.044）被确定为再通的统计学显著独立预测因素。随访监测中未发现出血情况。
支架辅助弹簧圈栓塞术治疗VBDAs似乎是可行且安全的。尽管SACE后立即不完全闭塞的发生率相对较高，但在大多数研究患者中，长期结果是可以接受的。主要分支受累以及有残留囊腔造影剂填充的弹簧圈栓塞动脉瘤可能易发生再通。
