Department of Radiology, Boston Medical Center, Boston, MA, USA.
Department of Radiology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada.
Interv Neuroradiol. 2021 Apr;27(2):172-180. doi: 10.1177/1591019920968370. Epub 2020 Oct 20.
Early major recurrence (EMR) of cerebral aneurysms treated by coiling has not been investigated. The purpose of this study is to characterize the frequency and risk factors of this phenomenon.
A retrospective review was performed of consecutive patients who presented with ruptured and unruptured cerebral aneurysms and underwent coiling from July 2009 to June 2019 at a university hospital. We defined EMR as recurrence of the aneurysm greater than its initial size within the first 6 months of an initial satisfactory coil embolization. Patient demographics, clinical information, aneurysm characteristics, angiographic and technical details were reviewed.
From July 2009 to June 2019, 338 aneurysms (190 unruptured aneurysms and 148 ruptured cerebral aneurysms) underwent coiling and satisfied our study criteria. Among these patients, 23 patients (19 ruptured and 4 unruptured aneurysms) were found to have recurrent aneurysm. Of those, 4 were found to have early major aneurysm regrowth occurring within 6 months after coiling (1.2%). The detection of the EMR was as early as 4 weeks and as late as 20 weeks after the initial coil embolization. The average detection time was 10 ± 7.2 weeks (mean ± SD, range:4-20 weeks). In each case, the recurrent aneurysm cavity was more than twice the initial size of presentation. All aneurysms with major recurrence were ruptured with low aspect ratios (dome height to neck ratio) and involved a communicating segment. All patients underwent successful retreatment of the recurrent aneurysm with good outcome.
Early major recurrence of treated aneurysms is a rare but important complication that harbors an impending risk of re-rupture. Early control angiography after endovascular coiling may be warranted for small ruptured aneurysms, even in cases in which the initial result seems technically satisfactory.
目前尚未研究过采用弹簧圈治疗的颅内动脉瘤的早期主要复发（EMR）。本研究的目的是描述这种现象的频率和危险因素。
对 2009 年 7 月至 2019 年 6 月在一所大学医院就诊的破裂和未破裂颅内动脉瘤患者进行了回顾性分析，这些患者接受了弹簧圈治疗。我们将 EMR 定义为初始满意的线圈栓塞后 6 个月内动脉瘤复发且大于初始大小。回顾了患者的人口统计学、临床信息、动脉瘤特征、血管造影和技术细节。
2009 年 7 月至 2019 年 6 月，338 个动脉瘤（190 个未破裂动脉瘤和 148 个破裂颅内动脉瘤）接受了弹簧圈治疗并符合我们的研究标准。在这些患者中，发现 23 例患者（19 例破裂和 4 例未破裂动脉瘤）存在复发动脉瘤。其中，4 例在弹簧圈栓塞后 6 个月内发现早期的主要动脉瘤再生长（1.2%）。EMR 的检测最早发生在初始线圈栓塞后 4 周，最晚发生在 20 周。平均检测时间为 10±7.2 周（平均值±标准差，范围：4-20 周）。在每个病例中，复发性动脉瘤腔均大于初始大小的两倍。所有具有大复发的动脉瘤均为破裂的、低形态比（瘤顶高度与瘤颈比）和涉及交通段。所有患者均成功地对复发性动脉瘤进行了再治疗，并取得了良好的结局。
经治疗的动脉瘤的早期主要复发是一种罕见但重要的并发症，存在再次破裂的潜在风险。即使在初始结果在技术上看起来令人满意的情况下，对于小破裂动脉瘤，可能需要在血管内弹簧圈治疗后进行早期的控制血管造影。
