Suzuki Kensuke, Suzuki Ryotaro, Takigawa Tomoji, Shimizu Nobuyuki, Matsumoto Yoshiyuki, Fujii Yoshiko, Inoue Yuki, Sugiura Yoshiki, Hirata Koji, Tsuda Kyoji, Kawamura Yosuke, Takano Issei, Nakae Ryuta, Nagaishi Masaya, Tanaka Yoshihiro, Hyodo Akio
Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital.
Neurol Med Chir (Tokyo). 2017 May 15;57(5):231-237. doi: 10.2176/nmc.oa.2016-0176. Epub 2017 Mar 2.
We investigated endovascular treatment for 10 mm or larger aneurysms in the internal carotid artery (IC), including the cavernous portion, the paraclinoid portion, and the posterior communication artery (PC). Between 2011 and 2014 at our hospital, there were 35 cases of aneurysms that were 10 mm or larger in the carotid artery. We analyzed these 35 cases retrospectively based on the size and location of the aneurysms, method of treatment, number of coils implanted, use of a stent, complications, rupture after treatment, ophthalmologic symptoms, and need for re-treatment. There was no bleeding after treatment. Of the 35 cases, four cases (11%) had permanent complications. Re-treatment was indicated in 11 cases (31%), including eight cases localized in the paraclinoid portion, two cases in the IC-PC, and one case in the cavernous portion. Among these re-treatment cases, two cases required a third treatment. Of the 16 cases with paraclinoid aneurysms, half required re-treatment. Of the 12 cases with ophthalmologic symptoms prior to treatment, 9 (75%) improved or had no change and 3 (25%) became worse. There were no complications in the 13 re-treatment procedures. Re-treatment is not uncommon, and a scheduled follow-up is needed. Coil embolization has been one of the main options for aneurysms that are 10 mm or larger in the IC. In the future, these large aneurysms will be treated with a flow diverter stent (FD).
我们研究了对颈内动脉（IC）包括海绵窦段、床突旁段及后交通动脉（PC）处直径10mm及以上动脉瘤的血管内治疗。2011年至2014年我院有35例颈动脉直径10mm及以上的动脉瘤病例。我们根据动脉瘤的大小和位置、治疗方法、植入弹簧圈数量、支架使用情况、并发症、治疗后破裂情况、眼科症状及再次治疗需求对这35例病例进行了回顾性分析。治疗后无出血情况。35例中，4例（11%）出现永久性并发症。11例（31%）需要再次治疗，其中8例位于床突旁段，2例位于颈内动脉-后交通动脉，1例位于海绵窦段。在这些再次治疗的病例中，2例需要第三次治疗。16例床突旁动脉瘤病例中，半数需要再次治疗。治疗前有眼科症状的12例中，9例（75%）症状改善或无变化，3例（25%）症状加重。13次再次治疗过程中无并发症发生。再次治疗并不少见，需要定期随访。弹簧圈栓塞一直是颈内动脉直径10mm及以上动脉瘤的主要治疗选择之一。未来，这些大型动脉瘤将采用血流导向支架（FD）进行治疗。
