Department of Neurosurgery, Koshigaya Municipal Hospital, Koshigaya City, Saitama, Japan.
Department of Neurosurgery, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
World Neurosurg. 2019 Jun;126:e753-e757. doi: 10.1016/j.wneu.2019.02.145. Epub 2019 Mar 7.
Stent-assisted coiling is recognized as effective to induce progressive occlusion and prevent recurrence of aneurysm. The long-term effects of stent-assisted coiling of sidewall-type and terminal-type aneurysms were comparatively analyzed focusing on the different hemodynamic characteristics.
Retrospective analysis included a total of 120 unruptured aneurysms in 116 consecutive patients who underwent stent-assisted coiling and completed 2-year follow-up. The stent systems, baseline characteristics, and postcoiling occlusion status of sidewall-type and terminal-type aneurysms were assessed.
Sidewall-type aneurysms had a significantly larger dome size (P = 0.02) and greater diameter of the parent vessel (P < 0.001) than terminal-type aneurysms. Initial occlusion status of the aneurysms was significantly maintained for 2 years in both sidewall-type and terminal-type aneurysms as follows: sidewall-type aneurysms showed that complete occlusion (CO), neck remnants (NRs), and body filling (BF) immediately posttreatment were significantly correlated with CO (P < 0.05), NRs (P < 0.01), and BF (P < 0.05) at 2-year follow-up, respectively, and terminal-type aneurysms showed that CO, NRs, and BF immediately posttreatment were significantly correlated with CO (P < 0.05), NRs (P < 0.05), and BF (P < 0.05) at 2-year follow-up, respectively. In addition, sidewall-type aneurysms with CO immediately posttreatment were significantly correlated with non-NRs (P < 0.01) and non-BF (P < 0.01) at 2-year follow-up.
Stent-assisted coiling allows higher coil packing for sidewall-type aneurysms, but the indication should be carefully considered for terminal-type aneurysms.
支架辅助弹簧圈栓塞术被认为能有效诱导渐进性闭塞并预防动脉瘤复发。本研究旨在对比分析不同血流动力学特征的侧壁型和末端型动脉瘤支架辅助弹簧圈栓塞的长期疗效。
回顾性分析了 116 例连续接受支架辅助弹簧圈栓塞治疗并完成 2 年随访的 120 个未破裂动脉瘤患者的临床资料。评估支架系统、基线特征和动脉瘤栓塞后的闭塞状态。
侧壁型动脉瘤瘤顶直径（P=0.02）和载瘤动脉直径（P<0.001）显著大于末端型动脉瘤。在侧壁型和末端型动脉瘤中，栓塞即刻的完全闭塞（CO）、瘤颈残留（NRs）和瘤体显影（BF）状态在 2 年随访时均能显著维持：侧壁型动脉瘤即刻 CO 与 2 年随访时 CO（P<0.05）、NRs（P<0.01）和 BF（P<0.05）显著相关，NRs 与 2 年随访时 BF（P<0.05）显著相关，BF 与 2 年随访时 CO（P<0.05）和 NRs（P<0.05）显著相关；而末端型动脉瘤即刻 CO 与 2 年随访时 CO（P<0.05）、NRs（P<0.05）和 BF（P<0.05）显著相关，NRs 与 2 年随访时 BF（P<0.05）显著相关，BF 与 2 年随访时 CO（P<0.05）显著相关。此外，侧壁型动脉瘤即刻 CO 与非 NRs（P<0.01）和非 BF（P<0.01）在 2 年随访时显著相关。
支架辅助弹簧圈栓塞术允许对侧壁型动脉瘤进行更高的线圈填塞，但对末端型动脉瘤的适应证应谨慎考虑。
