Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
World Neurosurg. 2019 Dec;132:e766-e774. doi: 10.1016/j.wneu.2019.08.020. Epub 2019 Aug 12.
Recurrence is one of the concerns even after successful endovascular treatment of intracranial aneurysms. We sought to determine the critical aneurysm volume and risk factors related to aneurysmal stability in patients undergoing coil embolization of intracranial aneurysms.
Aneurysm volume and follow-up imaging data were retrieved in 3042 patients with 3530 aneurysms who were treated with endovascular coil embolization from January 2006 to October 2016. We analyzed the anatomic outcome in relation to aneurysm volume and determined the critical aneurysm volume favoring coil embolization.
Recanalization rates were 2.8%, 6.3%, 19.4%, and 67.4% in each group with aneurysm volume of <10, 10-100, 100-1000, and >1000 mm, respectively. When we investigated the 100-1000 mm group, the recanalization rate remarkably increased at 500 mm (16.4% vs. 57.5%, P < 0.0001; odds ratio [OR], 6.968; 95% confidence interval [CI], 3.562-13.631). In the entire cohort, recanalization rates were significantly different between aneurysm volume of <500 and >500 mm (7.2% vs. 62.9%, respectively; P < 0.0001; OR, 21.848; 95% CI, 13.944-34.235). In aneurysm volumes of >500 mm, the location was a significant prognostic factor for long-term stability (posterior circulation vs. anterior circulation; OR, 4.737; 95% CI, 1.275-17.602; P = 0.020).
In our series of cerebral aneurysms treated with coil embolization, 500 mm was found to be the critical volume determining stability after coil embolization. Large volume aneurysms in the posterior circulation were especially prone to recanalization after coiling.
即使在颅内动脉瘤的血管内治疗成功后，复发仍然是一个关注点。我们旨在确定在接受颅内动脉瘤血管内线圈栓塞治疗的患者中，与动脉瘤稳定性相关的临界动脉瘤体积和危险因素。
回顾性分析 2006 年 1 月至 2016 年 10 月期间 3530 个颅内动脉瘤患者的 3042 例患者的动脉瘤体积和随访影像学资料。我们分析了与动脉瘤体积相关的解剖学结果，并确定了有利于线圈栓塞的临界动脉瘤体积。
动脉瘤体积<10、10-100、100-1000 和>1000mm 的各组再通率分别为 2.8%、6.3%、19.4%和 67.4%。当我们研究 100-1000mm 组时，在 500mm 时再通率显著增加（16.4%比 57.5%，P<0.0001；比值比[OR]，6.968；95%置信区间[CI]，3.562-13.631）。在整个队列中，动脉瘤体积<500mm 和>500mm 的再通率有显著差异（分别为 7.2%和 62.9%；P<0.0001；OR，21.848；95%CI，13.944-34.235）。在>500mm 的动脉瘤体积中，位置是长期稳定性的一个显著预后因素（后循环比前循环；OR，4.737；95%CI，1.275-17.602；P=0.020）。
在我们的颅内动脉瘤线圈栓塞治疗系列中，发现 500mm 是决定线圈栓塞后稳定性的临界体积。后循环的大体积动脉瘤尤其容易在 coil 栓塞后再通。
