Zhang Yisen, Yang Ming, Zhang Hongqi, Zhang Xiaolong, Li Youxiang, Jiang Chuhan, Liu Jian, Yang Xinjian
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Command of PLA, Wuhan, China.
World Neurosurg. 2017 Apr;100:22-29. doi: 10.1016/j.wneu.2016.12.107. Epub 2017 Jan 3.
To evaluate the safety and efficacy of endovascular treatments, including stent-assisted coiling, of very small (≤3 mm), ruptured intracranial aneurysms.
Ninety-three endovascularly treated patients with very small ruptured aneurysms were recruited from 4 high-volume centers between September 2010 and February 2014. Factors influencing procedural complications and outcomes were analyzed.
Fifty-one (54.8%) aneurysms were treated by stent-assisted coiling, 41 (44.1%) by coiling alone, and 1 (1.1%) by balloon-assisted coiling. Intraprocedural or postprocedural complications occurred in 13 patients (14.0%): coil migration in 1, intraprocedural rupture in 1, hydrocephalus in 6, and ischemic event in 1. No tested factor was able to predict procedural complications. Angiographic follow-up of 67 aneurysms (72%) revealed recurrence in 5 patients (7.5%). One recurrent case was treated initially by stent-assisted coiling and the remaining four by coiling alone (P = 0.044). Multivariate regression analysis showed that coiling alone was significantly associated with aneurysm recurrence (odds ratio, 13.8; 95% confidence interval, 1.1-175.3; P = 0.043).
Endovascular treatment of very small ruptured aneurysms was safe and effective and was not associated with a high rate of intraprocedural rupture. Treatment with the use of stents significantly lowered the recurrence rate without additional risks.
评估血管内治疗（包括支架辅助弹簧圈栓塞术）用于治疗非常小（≤3毫米）的破裂颅内动脉瘤的安全性和有效性。
2010年9月至2014年2月期间，从4个高容量中心招募了93例接受血管内治疗的非常小的破裂动脉瘤患者。分析影响手术并发症和预后的因素。
51例（54.8%）动脉瘤采用支架辅助弹簧圈栓塞术治疗，41例（44.1%）单纯采用弹簧圈栓塞术治疗，1例（1.1%）采用球囊辅助弹簧圈栓塞术治疗。13例患者（14.0%）发生术中或术后并发症：弹簧圈移位1例，术中破裂1例，脑积水6例，缺血事件1例。没有经过检验的因素能够预测手术并发症。对67例动脉瘤（72%）进行血管造影随访，发现5例（7.5%）复发。1例复发病例最初采用支架辅助弹簧圈栓塞术治疗，其余4例采用单纯弹簧圈栓塞术治疗（P = 0.044）。多因素回归分析显示，单纯弹簧圈栓塞术与动脉瘤复发显著相关（比值比，13.8；95%置信区间，1.1 - 175.3；P = 0.043）。
血管内治疗非常小的破裂动脉瘤是安全有效的，且与术中高破裂率无关。使用支架治疗可显著降低复发率且无额外风险。
