Department of Radiology, Inje University Busan Paik Hospital, Busan, South Korea.
Department of Neurosurgery, Dong-Eui Medical Center, Busan, South Korea.
Acta Neurochir (Wien). 2018 Dec;160(12):2411-2418. doi: 10.1007/s00701-018-3707-5. Epub 2018 Oct 23.
Proximal middle cerebral artery (M1 segment) aneurysms are relatively deeply located in neighboring lenticulostriate arteries, which make them unsuitable for microsurgery. We aimed to investigate the clinical and radiological outcomes of endovascular coiling of M1 segment aneurysms.
Between January 2003 and December 2014, we retrospectively reviewed the medical records of 52 patients (52 aneurysms) from four institutions who underwent endovascular coiling of M1 segment aneurysms. Patients who underwent clinical and radiologic follow-up for more than a year after the procedure were evaluated.
The aneurysms were located in the early frontal branch, early temporal branch, and lenticulostriate artery in 28, 15, and nine patients, respectively. Endovascular coiling was achieved in 51 cases and failed in one case. Of these 51 cases, 46 (90.2%) and five (9.8%) were non-ruptured and ruptured aneurysms, respectively. Initial angiographic results revealed complete occlusion in 26 (51.0%), residual neck in 16 (31.4%), and residual sac in nine (17.6%) cases. One failed case had a symptomatic procedural complication of thromboembolism. However, there was no permanent morbidity or mortality. Two major recanalization cases (3.9%) were retreated by endovascular coiling. On multivariable logistic regression analysis, aneurysmal recurrence was significantly related to aneurysm height (OR, 1.887; 95% CI, 1.107 to 3.217; p = 0.020), width (OR, 1.836; CI, 1.127 to 2.992; p = 0.015), and neck (OR, 4.017; CI, 1.220 to 13.232, p = 0.022).
Endovascular coiling of M1 segment aneurysms appeared to be a feasible treatment option with a relatively low-retreatment rate. Aneurysm size was statistically significantly associated with recurrence.
大脑中动脉近端（M1 段）动脉瘤位置较深，毗邻纹状体动脉，因此不适合进行显微手术。本研究旨在探讨血管内弹簧圈栓塞治疗 M1 段动脉瘤的临床和影像学转归。
回顾性分析 2003 年 1 月至 2014 年 12 月，4 家医疗机构的 52 例（52 个动脉瘤）M1 段动脉瘤患者的临床资料，所有患者均接受血管内弹簧圈栓塞治疗，术后临床和影像学随访时间超过 1 年。
28 例患者的动脉瘤位于额支前段，15 例位于颞支前段，9 例位于纹状体动脉。51 例患者的血管内弹簧圈栓塞治疗获得成功，1 例失败。其中，46 例（90.2%）为未破裂动脉瘤，5 例（9.8%）为破裂动脉瘤。初始血管造影结果显示完全闭塞 26 例（51.0%），瘤颈残留 16 例（31.4%），瘤腔残留 9 例（17.6%）。1 例治疗失败的患者发生血栓栓塞的症状性手术并发症，但无永久性残疾或死亡。2 例再通患者（3.9%）接受了再次血管内弹簧圈栓塞治疗。多变量逻辑回归分析显示，动脉瘤复发与动脉瘤高度（比值比，1.887；95%置信区间，1.107 至 3.217；p=0.020）、宽度（比值比，1.836；95%置信区间，1.127 至 2.992；p=0.015）和瘤颈（比值比，4.017；95%置信区间，1.220 至 13.232，p=0.022）有关。
血管内弹簧圈栓塞治疗 M1 段动脉瘤是一种可行的治疗方法，其再治疗率相对较低。动脉瘤大小与复发显著相关。
