复发性既往已行弹簧圈栓塞和/或支架辅助弹簧圈栓塞的颅内动脉瘤的外科治疗：一项针对75例患者的单中心经验
Surgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients.
作者信息
Liu Jonathan J, Nielsen Troels H, Abhinav Kumar, Lee Justin, Han Summer S, Marks Michael P, Do Huy M, Dodd Robert L, Steinberg Gary K
机构信息
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA.
Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA; Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
出版信息
World Neurosurg. 2019 Apr;124:e649-e658. doi: 10.1016/j.wneu.2018.12.171. Epub 2019 Jan 11.
BACKGROUND
Endovascular treated cerebral aneurysms have a greater recurrence rate compared with microsurgical clip ligation. Despite recent endovascular advances, microsurgical clip ligation might be the treatment of choice for certain previously endovascular treated recurrent aneurysms. We report on our single-center experience with 76 previously coiled and/or stent-coiled aneurysms.
OBJECTIVE
To analyze the surgical and radiologic outcome after clipping of previous endovascular treated recurrent cerebral aneurysms.
METHODS
Patients were retrospectively identified. Demographic data, aneurysm size, location, perioperative coil extraction, occlusion rate, and complication rate were recorded. Patients were divided into a previously coiled-only group (COG) and a previously stent-assisted coiled group (SAC).
RESULTS
Seventy-five patients with 76 aneurysms were included. Sixty-nine patients were included in the COG, 7 patients in the SAC group. Complete or acceptable near-complete occlusion was obtained in 95% of patients in the COG and 57% in the SAC group. Two patients in the COG (2.9%) died postoperatively of a major stroke. One patient died of rehemorrhage after wrapping of an aneurysm. Minor complications occurred in 8.7%. In the SAC group, the mortality was 0%, with 1 major stroke (14.2%), 1 minor stroke (14.2%), and 1 cranial nerve palsy (14.2%). Intraoperative coil extraction and previous stent-assisted coiling were significant predictors of complication rate (P = 0.025 and P = 0.0036 respectively). Previous stent-assisted coiling was a significant predictor of incomplete occlusion (P = 0.036).
CONCLUSIONS
Microsurgical clipping of previously endovascular treated recurrent aneurysms is an effective treatment with high obliteration rates. Previously stent-assisted coiling and intraoperative coil extraction are predictors of worse outcome and incomplete occlusion.
背景
与显微外科夹闭术相比，血管内治疗的脑动脉瘤复发率更高。尽管血管内治疗技术近期有所进展，但对于某些先前接受过血管内治疗的复发性动脉瘤，显微外科夹闭术可能是首选治疗方法。我们报告了我们单中心对76例先前采用弹簧圈栓塞和/或支架辅助弹簧圈栓塞治疗的动脉瘤的经验。
目的
分析对先前接受血管内治疗的复发性脑动脉瘤进行夹闭术后的手术和影像学结果。
方法
对患者进行回顾性识别。记录人口统计学数据、动脉瘤大小、位置、围手术期弹簧圈取出情况、闭塞率和并发症发生率。患者分为单纯先前弹簧圈栓塞组（COG）和先前支架辅助弹簧圈栓塞组（SAC）。
结果
纳入75例患者的76个动脉瘤。COG组纳入69例患者，SAC组纳入7例患者。COG组95%的患者实现了完全或可接受的近完全闭塞，SAC组为57%。COG组有2例患者（2.9%）术后死于严重卒中。1例患者在动脉瘤包裹后死于再出血。轻微并发症发生率为8.7%。在SAC组，死亡率为0%，有1例严重卒中（14.2%）、1例轻微卒中（14.2%）和1例脑神经麻痹（14.2%）。术中弹簧圈取出和先前的支架辅助弹簧圈栓塞是并发症发生率的显著预测因素（分别为P = 0.025和P = 0.0036）。先前的支架辅助弹簧圈栓塞是不完全闭塞的显著预测因素（P = 0.036）。
结论
对先前接受血管内治疗的复发性动脉瘤进行显微外科夹闭是一种有效的治疗方法，闭塞率高。先前的支架辅助弹簧圈栓塞和术中弹簧圈取出是预后较差和不完全闭塞的预测因素。
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