Han Yong-Feng, Jiang Peng, Tian Zhong-Bin, Chen Xi-Heng, Liu Jian, Wu Zhong-Xue, Gao Bu-Lang, Ren Chun-Feng
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China.
Front Neurol. 2022 Sep 29;13:938333. doi: 10.3389/fneur.2022.938333. eCollection 2022.
To explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision-making.
Forty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization, and characteristics of recurrent refractory aneurysms were analyzed.
Among the 49 patients with the second embolization, 5 were lost to follow-up, 9 recurred, and 35 did not. Univariate analysis showed that aneurysm size ( = 0.022), aneurysm classification ( = 0.014), and Raymond-Roy grade after the second embolization ( = 0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for the recurrence of aneurysms after the second embolization ( = 0.042). The complication rate after the second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17 ± 10.45 mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices.
Aneurysm occlusion status after the second embolization is an independent risk factor for the recurrence of intracranial aneurysms. Compared with near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatments with the use of multiple stents or flow diverting devices.
探讨复发性动脉瘤二次血管内栓塞术后复发的危险因素及复发性难治性动脉瘤的特点，以辅助临床决策。
回顾性纳入49例行重复栓塞术的复发性动脉瘤患者，分为复发组和未复发组。分析重复栓塞术的复发危险因素、并发症及随访结果，以及复发性难治性动脉瘤的特点。
49例接受二次栓塞的患者中，5例失访，9例复发，35例未复发。单因素分析显示，两组间动脉瘤大小（P = 0.022）、动脉瘤分级（P = 0.014）及二次栓塞后的Raymond-Roy分级（P = 0.001）存在统计学差异。多因素分析表明，Raymond-Roy分级是二次栓塞术后动脉瘤复发的独立危险因素（P = 0.042）。二次栓塞术后并发症发生率为4%。有5例复发性难治性动脉瘤，平均动脉瘤大小为23.17±10.45 mm，其中3例为巨大动脉瘤，2例为大型动脉瘤。为实现复发性难治性动脉瘤的完全或近完全栓塞，需要采用多种治疗方法，使用多个支架或血流导向装置。
二次栓塞术后动脉瘤的闭塞状态是颅内动脉瘤复发的独立危险因素。与近完全闭塞相比，完全闭塞可显著降低二次栓塞术后的复发风险。为实现完全或近完全闭塞，复发性难治性动脉瘤需要使用多个支架或血流导向装置进行多次治疗。
