La Pira Biagia, Brinjikji Waleed, Burrows Anthony M, Cloft Harry J, Vine Roanna L, Lanzino Giuseppe
Department of Neurologic Surgery, Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Radiology, Mayo Medical School, Mayo Clinic, Rochester, MN, USA.
Acta Neurochir (Wien). 2016 Nov;158(11):2053-2059. doi: 10.1007/s00701-016-2958-2. Epub 2016 Sep 19.
Internal carotid artery bifurcation aneurysms (ICAbifAs) present unique challenges to endovascular and surgical operators, and little is known about their natural history. We reviewed our institution's experience with ICAbifAs studying outcomes of surgical and endovascular management and natural history.
Consecutive patients with unruptured ICAbifAs evaluated and/or treated over an 8-year interval were studied. Baseline demographics, neurovascular risk factors, aneurysm location and size, clinical presentation, treatment recommendations, and outcomes were prospectively collected and retrospectively analyzed. Continuous variables were compared with Student's t test and categorical variables with Chi-square tests.
Fifty-nine patients with 61 unruptured ICAbifAs were included. Seven aneurysms were treated surgically (11.5 %), 22 underwent endovascular treatment (36 %), and 32 were managed conservatively (52.5 %). In the surgical group, short- and long-term complete aneurysm occlusion rates were 100 % with no cases of perioperative or long-term permanent morbidity or treatment-related mortality. In the endovascular group, two patients (11.7 %) with giant aneurysms had perioperative thromboembolic events with transient morbidity. There was one case of aneurysm rupture at follow-up in a giant aneurysm treated with partial coil embolization. Complete/near-complete occlusion rates were 63 %. There was one case of aneurysm rupture after 114 aneurysm-years of follow-up in the conservative management group (0.89 %/year), but no ruptures were observed in small aneurysms selected for conservative management.
Unruptured small ICAbifAs have a benign natural history. In patients selected for treatment, excellent results can be achieved in the vast majority of patients with judicious use of endovascular and surgical therapy.
颈内动脉分叉处动脉瘤（ICAbifAs）给血管内治疗和外科手术医生带来了独特的挑战，且对其自然病史了解甚少。我们回顾了本机构处理ICAbifAs的经验，研究手术和血管内治疗的结果以及自然病史。
对连续8年间评估和/或治疗的未破裂ICAbifAs患者进行研究。前瞻性收集并回顾性分析基线人口统计学、神经血管危险因素、动脉瘤位置和大小、临床表现、治疗建议及结果。连续变量采用学生t检验进行比较，分类变量采用卡方检验。
纳入59例患者的61个未破裂ICAbifAs。7个动脉瘤接受手术治疗（11.5%），22个接受血管内治疗（36%），32个采取保守治疗（52.5%）。手术组短期和长期动脉瘤完全闭塞率均为100%，无围手术期或长期永久性发病或治疗相关死亡病例。血管内治疗组，2例（11.7%）巨大动脉瘤患者发生围手术期血栓栓塞事件，伴有短暂性发病。1例部分弹簧圈栓塞治疗的巨大动脉瘤在随访期间发生动脉瘤破裂。完全/近完全闭塞率为63%。保守治疗组在114个动脉瘤年的随访中有1例动脉瘤破裂（0.89%/年），但选择保守治疗的小动脉瘤未观察到破裂。
未破裂的小型ICAbifAs自然病史良好。在选择治疗的患者中，明智地使用血管内和手术治疗，绝大多数患者可取得优异结果。
