Roh Haewon, Kim Junwon, Suh Sang-Il, Kwon Taek-Hyun, Yoon Wonki
Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Mar;64(2):217-228. doi: 10.3340/jkns.2020.0174. Epub 2021 Feb 26.
Given the high risk of rebleeding and recurrence of blood blister-like aneurysms (BBAs), we treated ruptured BBAs of the internal carotid artery (ICA) with stent-assisted coil embolization (SAC). This study aimed to evaluate the efficacy and safety of SACs.
We retrospectively reviewed clinical and radiological data from eight patients with ruptured BBAs of the supraclinoid ICA. The modified Rankin Scale (mRS) was used to assess clinical outcomes, while radiological outcomes were evaluated on angiographs. For a pooled analysis, data from literature reporting the outcomes of ruptured BBAs treated with SAC were collected and analyzed in conjunction with our data.
In our cohort, the mean Raymond classification score was 1.57±0.53 immediately after initial endovascular treatment. There were no perioperative complications or rebleeding events during the follow-up period. The mean mRS score at patient discharge was 1.00±0.81 and improved to 0.28±0.48 by the last follow-up day. The recurrence rate was 25% with an asymptomatic presentation and successful treatment with multiple stent insertion. Pooled analysis of 76 cases of SAC revealed a complete occlusion rate immediately after treatment of 54.8%, rebleeding rate 7.94%, and recurrence rate 24.2%. Good clinical outcomes with mRS score 0-2 were observed in 89.9% by the last clinical follow-up. Total mortality rate was 7.7%.
This treatment appears to not only minimize the hemodynamic burden on the fragile dome specific to this type of aneurysm, but also provides an opportunity for safe and effective treatment in recurrent cases.
鉴于血泡样动脉瘤（BBAs）再出血和复发风险高，我们采用支架辅助弹簧圈栓塞术（SAC）治疗颈内动脉（ICA）破裂的BBAs。本研究旨在评估SAC的有效性和安全性。
我们回顾性分析了8例鞍上ICA破裂BBAs患者的临床和影像学资料。采用改良Rankin量表（mRS）评估临床结局，通过血管造影评估影像学结局。为进行汇总分析，收集并分析了报告SAC治疗破裂BBAs结局的文献数据以及我们的数据。
在我们的队列中，初次血管内治疗后即刻的平均Raymond分级评分为1.57±0.53。随访期间无围手术期并发症或再出血事件。患者出院时的平均mRS评分为1.00±0.81，至最后随访日改善至0.28±0.48。无症状表现且多次置入支架成功治疗的复发率为25%。对76例SAC病例的汇总分析显示，治疗后即刻完全闭塞率为54.8%，再出血率为7.94%，复发率为24.2%。末次临床随访时，89.9%的患者mRS评分为0 - 2，临床结局良好。总死亡率为7.7%。
这种治疗方法似乎不仅能将此类动脉瘤特有的脆弱瘤顶的血流动力学负担降至最低，还为复发病例提供了安全有效的治疗机会。
