Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.
Neurosurgery. 2019 Feb 1;84(2):421-427. doi: 10.1093/neuros/nyy056.
Neck remnants are not uncommon after endovascular treatment of cerebral aneurysms. Critics of endovascular treatments for cerebral aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of aneurysm neck remnants following endovascular therapies.
To assess the clinical significance of residual aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral aneurysms.
We retrospectively reviewed the records of 1292 aneurysm cases that underwent endovascular treatment at 4 institutions. Aneurysms treated by primary coiling or stent-assisted coiling were included in the study; those treated by flow diversion were excluded Aneurysms with residual filling (i.e., Raymond-Roy Occlusion Classification II, neck remnant; or III, residual aneurysm filling) were assessed for their risk of subsequent rupture.
A total of 626 aneurysms were identified as having residual filling immediately posttreatment. Of these, 13 aneurysms (2.1%) ruptured during the follow-up period (mean 7.3 mo; range 1-84 mo). Eleven of the 13 (84.6%) were ruptured at presentation. Rupture at presentation, the size of the aneurysm, and the increasing age of the patient were predictive of posttreatment rupture.
We found that unruptured aneurysms with residual necks following endovascular treatment posed a very low risk of rupture (0.6%). However, patients presenting with ruptured aneurysms had a higher risk of rerupture from a neck remnant (3.4%). These results highlight the importance of achieving complete angiographic occlusion of ruptured aneurysms.
在脑动脉瘤的血管内治疗后，颈部残端并不少见。批评者认为血管内治疗脑动脉瘤时，颈部残端是支持显微夹闭的证据。然而，研究未能评估血管内治疗后动脉瘤颈部残端的真正临床意义。
评估残留动脉瘤颈部的临床意义，并确定脑动脉瘤血管内治疗后线圈栓塞或支架辅助线圈栓塞后破裂的发生率。
我们回顾了 4 家机构的 1292 例接受血管内治疗的动脉瘤病例记录。本研究纳入了经初次线圈栓塞或支架辅助线圈栓塞治疗的动脉瘤，排除了采用血流转向治疗的动脉瘤。对有残留充盈（即 Raymond-Roy 闭塞分类 II 级，颈部残端；或 III 级，残留动脉瘤充盈）的动脉瘤进行评估，以确定其随后破裂的风险。
共有 626 个动脉瘤被确定为治疗后有残留充盈。在这些动脉瘤中，有 13 个（2.1%）在随访期间破裂（平均 7.3 个月；范围 1-84 个月）。13 个中的 11 个（84.6%）在就诊时破裂。就诊时破裂、动脉瘤大小和患者年龄增加是治疗后破裂的预测因素。
我们发现，血管内治疗后有残留颈部的未破裂动脉瘤破裂风险非常低（0.6%）。然而，破裂的动脉瘤患者有更高的再破裂风险（3.4%）来自颈部残端。这些结果强调了实现破裂动脉瘤完全血管造影闭塞的重要性。
