Kim Hyun Sik, Cho Byung Moon, Yoo Chan Jong, Choi Dae Han, Hyun Dong Keun, Shim Yu Shik, Song Joon Ho, Oh Jae Keun, Ahn Jun Hyong, Kim Ji Hee, Chang In Bok
Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Sep;64(5):751-762. doi: 10.3340/jkns.2021.0010. Epub 2021 Jul 22.
Endovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups.
Between January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with single-microcatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively.
Clinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01).
Long-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.
对于宽颈颅内动脉瘤，血管内治疗具有挑战性，因为弹簧圈容易疝入载瘤动脉，导致血栓栓塞事件或血管闭塞。本研究旨在比较支架辅助、双微导管或单微导管组治疗宽颈动脉瘤的长期血管造影结果。
选取2003年1月至2016年10月期间，108例采用血管内弹簧圈栓塞治疗、瘤颈宽度大于4mm且随访期超过3年的动脉瘤。我们采用单微导管、双微导管和支架辅助技术进行弹簧圈栓塞。使用雷蒙德-罗伊闭塞分类法（RROC）评估血管造影结果。对所有医学和血管造影记录进行回顾性分析。
对108例宽颈动脉瘤进行了临床和血管造影分析。术后即刻结果显示，66例（61.1%）为RROC I级（完全闭塞），36例（33.3%）为II级（残留瘤颈），6例（5.6%）为III级（残留瘤囊）。最终随访结果显示，48例（44.4%）为I级，49例（45.4%）为II级，11例（10.2%）为III级。在总共45例（41.6%）的影像学复发中，有21例（19.4%）为需要额外治疗的主要复发，24例（22.2%）为次要复发。最终随访血管造影结果显示，支架辅助组与其他组之间存在统计学显著差异（p<0.01）。
长期随访血管造影表明，支架辅助技术的完全闭塞率优于其他两种技术。
