da Silva Júnior Nilton Rocha, Trivelato Felipe Padovani, Nakiri Guilherme Seizem, Rezende Marco Túlio Salles, de Castro-Afonso Luís Henrique, Abud Thiago Giansante, Vanzin José Ricardo, Manzato Luciano Bambini, Ulhôa Alexandre Cordeiro, Abud Daniel Giansante, Giannetti Alexandre Varella
Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil.
Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
J Cerebrovasc Endovasc Neurosurg. 2021 Sep;23(3):221-232. doi: 10.7461/jcen.2021.E2021.03.001. Epub 2021 Sep 2.
Total aneurysm occlusion is crucial for the prevention of rebleeding of a ruptured aneurysm or to avoid rupture of an unruptured lesion. Both surgical and endovascular embolization fail to achieve complete aneurysm occlusion in all the cases. The objective of the study was to establish the safety and efficacy of endovascular treatment for previously clipped residual or recurrent aneurysms.
This was an observational, retrospective study of patients harboring incompletely occluded intracranial aneurysms after clipping who underwent endovascular treatment. Patients were treated using 4 different techniques: (1) simple coiling, (2) balloon remodeling, (3) stent-assisted coiling, and (4) flow diversion. Analyses were performed to identify predictors of total aneurysm occlusion, recanalization and complications.
Between May 2010 and September 2018, 70 patients harboring incompletely occluded intracranial aneurysms after clipping met the inclusion criteria in 5 centers. The mean residual aneurysm size was 7.5 mm. Fifty-nine aneurysms were unruptured. Total aneurysm occlusion was achieved in 75.3% of the aneurysms after 1 year. All aneurysms treated with flow diversion revealed complete occlusion according to control angiography. Recanalization was observed in 14.5%. Permanent morbidity and mortality occurred in 2.9% and 1.4% of the patients, respectively.
Endovascular treatment of recurrent or residual aneurysms after surgical clipping was safe and efficacious. Flow diversion seems to be associated with better anatomical results. A more rigid study, a larger group of patients, and longterm follow-up are required to provide stronger conclusions about the best approach for residual clipped aneurysms.
完全闭塞动脉瘤对于预防破裂动脉瘤再出血或避免未破裂病变破裂至关重要。手术和血管内栓塞在所有病例中均未能实现动脉瘤的完全闭塞。本研究的目的是确定血管内治疗先前夹闭的残余或复发性动脉瘤的安全性和有效性。
这是一项对接受血管内治疗的夹闭术后颅内动脉瘤未完全闭塞患者的观察性回顾性研究。患者采用4种不同技术进行治疗：（1）单纯弹簧圈栓塞，（2）球囊重塑，（3）支架辅助弹簧圈栓塞，（4）血流导向。进行分析以确定动脉瘤完全闭塞、再通和并发症的预测因素。
2010年5月至2018年9月，5个中心的70例夹闭术后颅内动脉瘤未完全闭塞患者符合纳入标准。残余动脉瘤平均大小为7.5mm。59个动脉瘤未破裂。1年后75.3%的动脉瘤实现了完全闭塞。根据对照血管造影，所有接受血流导向治疗的动脉瘤均显示完全闭塞。观察到再通率为14.5%。患者的永久性致残率和死亡率分别为2.9%和1.4%。
手术夹闭后复发性或残余性动脉瘤的血管内治疗安全有效。血流导向似乎与更好的解剖学结果相关。需要更严格的研究、更大的患者群体和长期随访，以得出关于残余夹闭动脉瘤最佳治疗方法的更有力结论。
