Brzegowy Paweł, Kucybała Iwona, Krupa Kamil, Łasocha Bartłomiej, Wilk Aleksander, Latacz Paweł, Urbanik Andrzej, Popiela Tadeusz J
Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland.
Students' Scientific Group at the Chair of Radiology, Jagiellonian University Medical College, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2019 Sep;14(3):451-460. doi: 10.5114/wiitm.2019.81406. Epub 2019 Jan 21.
The anterior communicating artery (ACoA) is the most common location of intracranial aneurysms, observed in 35% of cases. Endovascular treatment has become an alternative to surgical clipping and the primary method of choice.
To assess the treatment results of ruptured and unruptured ACoA aneurysms and to assess the incidence of intraprocedural complications and various factors influencing these aspects.
One hundred and eleven embolizations of ACoA aneurysms (80.7% ruptured and 19.3% unruptured) were retrospectively analysed. The methods of embolization were: coiling, balloon-assisted coiling, stent-assisted coiling. Morphology and dimensions of aneurysms were assessed on 3D digital subtraction angiography (DSA) images. Medical records were analysed for patient's clinical status at admission, intraprocedural complications, follow-up examination and modified Rankin Scale (mRS) score 1 month after discharge.
Immediately after the procedure 56.9% of patients had Raymond-Roy Occlusion Classification (RROC) class I, 37.6% class II and 5.5% class III. The overall intraprocedural complication rate was 6.6%. There were significantly more cases of bleeding (p = 0.012) and coil prolapse (p = 0.012) during the procedures ending with higher packing density. Twenty-eight (25.7%) patients died during hospital stay, 27 (96.4%) with ruptured aneurysm. In the follow-up of 41 patients, RROC was the same or improved in 73.2% of cases and recanalization occurred in 26.8%. Six patients with aneurysm recanalization underwent repeat embolization.
Endovascular embolization of ACoA aneurysms is an effective and safe treatment method. The most powerful factor influencing the incidence of complications is packing density. Superior orientation of the dome, initial incomplete embolization and poor outcome in mRS scale are factors predisposing to ACoA aneurysm recurrence.
前交通动脉（ACoA）是颅内动脉瘤最常见的发生部位，35%的病例中可观察到。血管内治疗已成为手术夹闭的替代方法及首选的主要治疗手段。
评估破裂和未破裂的ACoA动脉瘤的治疗效果，并评估术中并发症的发生率以及影响这些方面的各种因素。
回顾性分析111例ACoA动脉瘤栓塞术（80.7%为破裂动脉瘤，19.3%为未破裂动脉瘤）。栓塞方法包括：弹簧圈栓塞、球囊辅助弹簧圈栓塞、支架辅助弹簧圈栓塞。在三维数字减影血管造影（DSA）图像上评估动脉瘤的形态和大小。分析病历以了解患者入院时的临床状况、术中并发症、随访检查以及出院后1个月的改良Rankin量表（mRS）评分。
术后即刻，56.9%的患者为Raymond-Roy闭塞分级（RROC）I级，37.6%为II级，5.5%为III级。术中总体并发症发生率为6.6%。在填塞密度较高的手术过程中，出血（p = 0.012）和弹簧圈脱垂（p = 0.012）的病例明显更多。28例（25.7%）患者在住院期间死亡，27例（96.4%）为破裂动脉瘤。在对41例患者的随访中，73.2%的病例RROC相同或改善，26.8%发生再通。6例动脉瘤再通患者接受了重复栓塞。
ACoA动脉瘤的血管内栓塞是一种有效且安全的治疗方法。影响并发症发生率的最主要因素是填塞密度。瘤顶的优势方向、初始栓塞不完全以及mRS量表评分结果不佳是ACoA动脉瘤复发的易感因素。
