Linfante Italo, Andreone Vincenzo, Ravelo Natalia, Starosciak Amy K, Arif Bilal, Shallwani Hussain, Tze Man Kan Peter, McDermott Michael W, Dabus Guilherme
Neurology, Miami Cardiac & Vascular Institute/Miami Neuroscience Institute, Baptist Health South Florida, Miami, USA.
Neurology & Stroke Unit, Ospedale Antonio Cardarelli, Napoli, ITA.
Cureus. 2020 May 26;12(5):e8290. doi: 10.7759/cureus.8290.
Objective Giant intracranial aneurysms (GIAs) are associated with a high risk of rupture and have a high mortality rate when they rupture (65-100%). The traditional microsurgical approach to secure these lesions is challenging, and as such endovascular embolization has been increasingly selected as a treatment option. Methods We performed a retrospective analysis of consecutive patients with ruptured and unruptured GIAs at three medical centers from October 2008 to April 2016. Clinical follow-up and digital subtraction angiography were conducted at six months post-treatment. Chi-square analysis was used to determine differences in outcomes between anterior and posterior circulation aneurysms and if a pipeline embolization device (PED) provided favorable outcomes in unruptured GIAs. Results A total of 45 consecutive patients (mean/median age = 57/59; range: 16-82 years) were included. The mean/median aneurysm size was 29.9/28.3 mm (range: 25-50 mm). Eight (18%) patients presented with aneurysmal subarachnoid hemorrhage and 37 (82%) with unruptured GIAs. Twenty-eight (62%) were treated with a PED: 11 (24.4%) with one PED, 1 (2.2%) with PED + coils, 11 (24.4%) with more than one PED, and 5 (13.5%) with multiple PED + coils. The overall mortality rate was 3/45 (6.7%). No deaths were procedure-related. Five (11.1%) patients experienced ischemic stroke but only 2 had a 90-day modified Rankin Scale (mRS) score of ≥3. Of 33 patients available for six-month angiography, Raymond scale (RS) scores were 1, 2, and 3 for 23/45 (70%), 7/45 (20.9%), and 3/45 (9.1%), respectively. Chi-square test demonstrated that overall, anterior circulation GIAs had better clinical (mRS score) and radiographic (RS score) outcomes than posterior GIAs. PED alone provided similar clinical mRS outcomes but had a higher rate of complete occlusion at six months compared with PED + coils and coils alone in unruptured GIAs (p < 0.05). Conclusions Endovascular embolization using PED or PED + coils appears to be a moderately safe and effective treatment option for patients with GIAs.
目的 巨大颅内动脉瘤（GIAs）破裂风险高，破裂时死亡率也高（65 - 100%）。传统的显微手术方法治疗这些病变具有挑战性，因此血管内栓塞越来越多地被选作一种治疗选择。方法 我们对2008年10月至2016年4月期间三个医疗中心连续收治的破裂和未破裂GIAs患者进行了回顾性分析。治疗后6个月进行临床随访和数字减影血管造影。采用卡方分析确定前循环和后循环动脉瘤在治疗结果上的差异，以及管道栓塞装置（PED）在未破裂GIAs中是否能提供良好的治疗效果。结果 共纳入45例连续患者（平均/中位年龄 = 57/59岁；范围：16 - 82岁）。动脉瘤平均/中位大小为29.9/28.3 mm（范围：25 - 50 mm）。8例（18%）患者出现动脉瘤性蛛网膜下腔出血，37例（82%）为未破裂GIAs。28例（62%）采用PED治疗：11例（24.4%）使用1个PED，1例（2.2%）使用PED + 弹簧圈，11例（24.4%）使用1个以上PED，5例（13.5%）使用多个PED + 弹簧圈。总死亡率为3/45（6.7%）。无手术相关死亡。5例（11.1%）患者发生缺血性卒中，但只有2例90天改良Rankin量表（mRS）评分≥3。在可进行6个月血管造影的33例患者中，Raymond量表（RS）评分1、2和3级的分别有23/45（70%）、7/45（20.9%）和3/45（9.1%）。卡方检验表明，总体而言，前循环GIAs在临床（mRS评分）和影像学（RS评分）结果方面优于后循环GIAs。在未破裂GIAs中，单独使用PED与使用PED + 弹簧圈及单独使用弹簧圈相比，临床mRS结果相似，但6个月时完全闭塞率更高（p < 0.05）。结论 对于GIAs患者，使用PED或PED + 弹簧圈进行血管内栓塞似乎是一种中度安全有效的治疗选择。
