Aguilar-Salinas Pedro, Brasiliense Leonardo B, Santos Roberta, Cortez Gustavo, Gonsales Douglas, Aghaebrahim Amin, Sauvageau Eric, Hanel Ricardo A
Neurosurgery, Banner University Medical Center Tucson, Tucson, USA.
Neurosurgery, University of Arizona, Tucson, USA.
Cureus. 2019 Jun 6;11(6):e4847. doi: 10.7759/cureus.4847.
Wide-necked intracranial aneurysms (IAs) are complex lesions that may require different microsurgical or endovascular strategies, and stent-assisted coiling (SAC) has emerged as a feasible alternative to treat this subset of aneurysms.
The objective was to assess the rate of complications of unruptured wide-necked IAs treated with SAC. We retrospectively identified patients with unruptured wide-necked IAs treated with SAC. Medical charts, procedure reports, and imaging studies were analyzed.
One hundred twenty patients harboring 124 unruptured wide-necked IAs were included. Ninety-two aneurysms (74.2%) were located in the anterior circulation. The median aneurysm size was 7 mm (IQR = 5-10). The immediate complete aneurysm occlusion rate was 29% (36/124). The rate of procedural complications was 3.3 % (4/120), which included 2 intraprocedural aneurysm ruptures, 1 immediate postprocedure aneurysm rupture, and 1 vessel occlusion rescued with an open-cell stent. The median follow-up time was 21 months (IQR = 10.3-40.9). Kaplan-Meier analysis estimated a median time of complete aneurysm occlusion of 6.3 months (95%CI = 3.8-7.8). At 30-day follow-up, 80.7% of patients had a Glasgow Outcome Score (GOS) of 5 and at the latest follow-up 83.9%. Imaging follow-up was available for 102 patients. The rate of complete aneurysm occlusion was 73.5% (75/102), severe in-stent stenosis (>50%) was found in 1% (1/102), the recanalization rate was 6.6% (5/75), and the retreatment rate was 7.8% (8/102).
SAC remains a safe and effective technique to treat wide-necked IAs, providing a low rate of complications and recanalization with excellent long-term aneurysm occlusion rates.
宽颈颅内动脉瘤（IAs）是复杂病变，可能需要不同的显微外科或血管内治疗策略，而支架辅助弹簧圈栓塞术（SAC）已成为治疗这类动脉瘤的一种可行替代方法。
目的是评估采用SAC治疗未破裂宽颈IAs的并发症发生率。我们回顾性确定了采用SAC治疗的未破裂宽颈IAs患者。分析了病历、手术报告和影像学研究。
纳入了120例患者，共124个未破裂宽颈IAs。92个动脉瘤（74.2%）位于前循环。动脉瘤中位大小为7mm（四分位间距IQR = 5 - 10）。即刻完全动脉瘤闭塞率为29%（36/124）。手术并发症发生率为3.3%（4/120），包括2例术中动脉瘤破裂、1例术后即刻动脉瘤破裂以及1例采用开孔支架挽救的血管闭塞。中位随访时间为21个月（IQR = 10.3 - 40.9）。Kaplan - Meier分析估计完全动脉瘤闭塞的中位时间为6.3个月（95%置信区间CI = 3.8 - 7.8）。在30天随访时，80.7%的患者格拉斯哥预后评分（GOS）为5分，在最近一次随访时为83.9%。102例患者有影像学随访资料。完全动脉瘤闭塞率为73.5%（75/102），发现严重支架内狭窄（>50%）的比例为1%（1/102），再通率为6.6%（5/75），再治疗率为7.8%（8/102）。
SAC仍然是治疗宽颈IAs的一种安全有效的技术，并发症发生率和再通率低，长期动脉瘤闭塞率良好。
