Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Magdeburg, Leipzigerstraße 44, 39120, Magdeburg, Germany.
Cardiovasc Intervent Radiol. 2021 Apr;44(4):587-595. doi: 10.1007/s00270-020-02718-9. Epub 2021 Jan 3.
With the introduction of new devices and the development of approved devices, endovascular techniques are more and more considered as a treatment option for middle cerebral artery aneurysms (MCA). In this study, we present data on ruptured MCA aneurysms that were treated endovascularly in our hospital.
In a retrospective case series of ruptured MCA bifurcation aneurysms, 118 (94%) cases were managed endovascularly between May 2008 and July 2017. Most were managed with coiling (= 62) and the remaining were managed with stent-assisted-coiling (= 35) and endovascular flow disruptor (WEB-device) (= 21). We measured the clinical outcome at the time of discharge and long-term follow-up on the modified Rankin Scale (mRS) and evaluated the rates of periprocedural complications and retreatment.
A good clinical outcome (mRS 0-2) at discharge was achieved in 58.5% of these cases. Mortality rate was 19.5%. Nine aneurysms required retreatment. Eighty-three percent demonstrated a good clinical outcome at long-term follow-up (mRS 0-2). In total, 6 (5.1%) procedure-related complications and 10 (8.5%) disease-related complications occurred. No significant difference between reintervention, complications or outcome was found between the employment of different devices (P > 0.05). Endovascular treatment of ruptured MCA aneurysms at our practice showed similar morbidity and mortality to data published about surgical clipping.
The endovascular device evolution permits a feasible and safe treatment of ruptured MCA bifurcation aneurysms. Endovascular treatment can therefore be considered as an alternative treatment option to microsurgery for this type of aneurysm.
随着新设备的引入和已批准设备的发展，血管内技术越来越多地被认为是治疗大脑中动脉动脉瘤（MCA）的一种选择。在本研究中，我们介绍了在我院接受血管内治疗的破裂 MCA 分叉部动脉瘤的数据。
在一项回顾性破裂 MCA 分叉部动脉瘤病例系列研究中，2008 年 5 月至 2017 年 7 月间，我们对 118 例（94%）破裂 MCA 分叉部动脉瘤患者进行了血管内治疗。其中大部分采用弹簧圈治疗（=62 例），其余采用支架辅助弹簧圈治疗（=35 例）和血管内血流阻断装置（WEB 装置）治疗（=21 例）。我们在出院时和长期随访时（改良 Rankin 量表，mRS）测量临床结果，并评估围手术期并发症和再治疗率。
这些患者中有 58.5%在出院时获得了良好的临床结果（mRS 0-2）。死亡率为 19.5%。9 个动脉瘤需要再次治疗。83%的患者在长期随访时（mRS 0-2）获得了良好的临床结果。总的来说，发生了 6 例（5.1%）与操作相关的并发症和 10 例（8.5%）与疾病相关的并发症。不同设备的使用在再干预、并发症或结果方面没有显著差异（P>0.05）。我们的实践中血管内治疗破裂 MCA 动脉瘤的发病率和死亡率与已发表的关于手术夹闭的研究相似。
血管内设备的发展使得破裂 MCA 分叉部动脉瘤的治疗变得可行且安全。因此，血管内治疗可以被认为是此类动脉瘤的一种替代治疗选择。
