Department of Neurosurgery, Inha University Hospital, Incheon, Korea (Republic of).
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (Republic of).
Clin Neuroradiol. 2023 Sep;33(3):653-659. doi: 10.1007/s00062-022-01252-0. Epub 2023 Jan 3.
Stent protective or balloon remodeling techniques have enabled coil embolization of complexly configured aneurysms. Still, the utility of such methods may be limited in some small-caliber and/or inherently tortuous lesions. The present study was conducted to examine the efficacy of microcatheter protection (MCP) when applied in these circumstances.
This retrospective review included 432 patients with 452 intracranial aneurysms subjected to MCP between April 2001 and January 2021. All available medical records and radiologic data were analyzed, focusing on strategic, safety, and efficacy aspects of the procedures.
In a majority (255/452, 56.4%) of cases, MCP was applied throughout entire coiling procedures, as opposed to coil framing (137/452, 30.3%) or filling/finishing (60/452, 13.3%) only. Lesions of the middle cerebral artery (54.9%) predominated, followed by anterior (12.4%) and posterior (11.1%) communicating artery aneurysms. Stent protection was also used occasionally (46/452, 10.2%). Procedural morbidity was low (3/432, 0.7%), limited to symptomatic thromboembolism and procedural leakage, and there were no deaths. Occlusion was successfully achieved by MCP in 424 aneurysms (93.8%). During the follow-up period (mean, 43.4 ± 30.4 months), satisfactory occlusion was documented in 406 of 440 (92.3%) aneurysms.
MCP is feasible and safe for coil embolization of intracranial aneurysms, in conjunction with multicatheter, balloon, or stenting techniques. MCP may have merit in small-sized or tortuous lesions not amenable to balloon or stent usage, often eliminating the need for stenting altogether.
支架保护或球囊重塑技术使复杂形态的动脉瘤能够进行线圈栓塞。然而，在某些小口径和/或固有迂曲的病变中，这些方法的应用可能受到限制。本研究旨在探讨在这些情况下应用微导管保护（MCP）的效果。
本回顾性研究纳入了 2001 年 4 月至 2021 年 1 月期间接受 MCP 治疗的 432 例 452 个颅内动脉瘤患者。分析了所有可获得的病历和影像学资料，重点关注手术的策略、安全性和效果。
在大多数（255/452，56.4%）病例中，MCP 应用于整个线圈栓塞过程，而不是线圈框定（137/452，30.3%）或填充/完成（60/452，13.3%）。大脑中动脉病变（54.9%）最为常见，其次是前交通动脉（12.4%）和后交通动脉（11.1%）动脉瘤。偶尔也使用支架保护（46/452，10.2%）。手术发病率低（3/432，0.7%），仅限于症状性血栓栓塞和手术渗漏，无死亡病例。MCP 成功实现了 424 个动脉瘤（93.8%）的闭塞。在随访期间（平均 43.4±30.4 个月），406 个（92.3%）动脉瘤的闭塞效果满意。
MCP 结合多导管、球囊或支架技术，对颅内动脉瘤的线圈栓塞是可行和安全的。MCP 对于不适合使用球囊或支架的小尺寸或迂曲病变可能具有优势，通常可以完全避免支架的使用。
