Waldeck Stephan, Chapot René, von Falck Christian, Froelich Matthias F, Brockmann Marc, Overhoff Daniel
Department of Diagnostic and Interventional Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Straße 170, 56072 Koblenz, Germany.
Institute of Neuroradiology, University Medical Centre, Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
J Clin Med. 2022 Jan 28;11(3):677. doi: 10.3390/jcm11030677.
Intracranial aneurysms are commonly treated with balloon-assisted endovascular coiling because the balloon allows for the control und modulation of wide-necked aneurysms and the coil basket. However, this approach might be associated with a higher complication rate. This retrospective study compared the multimodal results between balloon-assisted coiling of aneurysms (group 1) and coiling without balloon assistance (group 2).
We included 67 patients with unruptured intracranial aneurysms in this retrospective analysis; acutely ruptured aneurysms were excluded from the analysis. We divided these patients into two groups and evaluated them for symptomatic thromboembolic complications in the course of intracranial aneurysm treatment. All patients had an intrainterventional neurophysiological monitoring (IINM) and a pre- and postinterventional NIH Stoke Scale (NIHSS) survey and MR imaging. Multiple logistic regression was used to assess whether balloon-assisted coiling increased the rate of thromboembolic complications. Periprocedural aneurysm hemorrhage did not occur in any of the cases.
We detected no statistically significant difference in rates of neurophysiological disturbances (19.5% (group 1) versus 34.6% (group 2); = 0.249). There was no association with age, gender, or aneurysm location. The occurrence of new diffusion-weighted defects was not statistically significantly different (19.5% (group 1) versus 35.0% (group 2); = 0.166). The difference in NIHSS before and after the intervention showed also no statistical significance in both groups ( = 0.426).
The use of balloon-assisted coiling did not increase the rate of neurological disturbances during endovascular coiling. MR imaging and NIHSS survey also showed no increased risk of embolization from balloon-assisted aneurysm coiling. IINM is a central aspect of care during endovascular coiling as it can substantially decrease morbidity.
颅内动脉瘤通常采用球囊辅助血管内栓塞治疗，因为球囊有助于控制和调节宽颈动脉瘤及弹簧圈。然而，这种方法可能与较高的并发症发生率相关。本回顾性研究比较了动脉瘤球囊辅助栓塞（第1组）和无球囊辅助栓塞（第2组）的多模式结果。
本回顾性分析纳入67例未破裂颅内动脉瘤患者；急性破裂的动脉瘤被排除在分析之外。我们将这些患者分为两组，并评估他们在颅内动脉瘤治疗过程中出现的症状性血栓栓塞并发症。所有患者均接受介入神经生理监测（IINM）以及介入前后的美国国立卫生研究院卒中量表（NIHSS）调查和磁共振成像。采用多因素逻辑回归分析评估球囊辅助栓塞是否会增加血栓栓塞并发症的发生率。所有病例均未发生围手术期动脉瘤出血。
我们发现神经生理紊乱发生率无统计学显著差异（第1组为19.5%，第2组为34.6%；P = 0.249）。与年龄、性别或动脉瘤位置无关。新的弥散加权缺损的发生率也无统计学显著差异（第1组为19.5%，第2组为35.0%；P = 0.166）。两组干预前后NIHSS的差异也无统计学意义（P = 0.426）。
球囊辅助栓塞在血管内栓塞过程中并未增加神经功能障碍的发生率。磁共振成像和NIHSS调查也显示球囊辅助动脉瘤栓塞不会增加栓塞风险。IINM是血管内栓塞治疗过程中的核心护理环节，因为它可显著降低发病率。
