Piao Jianmin, Luan Tengfei, Qu Lai, Yu Jinlu
Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Department of Intensive Care, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Med Int (Lond). 2021 Apr 12;1(1):1. doi: 10.3892/mi.2021.1. eCollection 2021 Mar-Apr.
Following the clipping of intracranial aneurysms, post-clipping residual or recurrent aneurysms (PCRRAs) can occur. In recent years, the incidence of PCRRAs has increased due to a prolonged follow-up period and advanced imaging techniques. However, several aspects of intracranial PCRRAs remain unclear. Therefore, the present study performed an in-depth review of the literature on PCRRAs. Herein, a summary of PCRRAs that can be divided into the following two categories is presented: i) Those occurring after the incomplete clipping of an aneurysm, where the residual aneurysm regrows into a PCRRA; and ii) those occurring after the complete clipping of an aneurysm, in which a aneurysm occurs at the original aneurysm site. Currently, digital subtracted angiography remains the gold standard for the imaging diagnosis of PCRRAs as it can eliminate metallic clip artifacts. Intracranial symptomatic PCRRAs should be actively treated, particularly those that have ruptured. A number of methods are currently available for the treatment of intracranial PCRRAs; these mainly include re-clipping, endovascular treatment (EVT) and bypass surgery. Currently, re-clipping remains the most effective method used to treat PCRRAs; however, it is a very difficult procedure to perform. EVT can also be used to treat intracranial PCRRAs. EVT methods include coiling (stent- or balloon-assisted) and flow-diverting stents (or coiling-assisted). Bypass surgery can be selected for difficult-to-treat, complex PCRRAs. On the whole, following appropriate treatment, the majority of intracranial PCRRAs achieve a high occlusion rate and a good prognosis.
颅内动脉瘤夹闭术后，可能会出现夹闭术后残余或复发性动脉瘤（PCRRAs）。近年来，由于随访期延长和先进的成像技术，PCRRAs的发生率有所增加。然而，颅内PCRRAs的几个方面仍不清楚。因此，本研究对PCRRAs的文献进行了深入回顾。在此，对可分为以下两类的PCRRAs进行总结：i）动脉瘤夹闭不完全后发生的，残余动脉瘤发展为PCRRAs；ii）动脉瘤完全夹闭后发生的，在原动脉瘤部位出现新的动脉瘤。目前，数字减影血管造影术仍是PCRRAs成像诊断的金标准，因为它可以消除金属夹伪影。颅内有症状的PCRRAs应积极治疗，尤其是那些已经破裂的。目前有多种方法可用于治疗颅内PCRRAs；这些方法主要包括再次夹闭、血管内治疗（EVT）和搭桥手术。目前，再次夹闭仍然是治疗PCRRAs最有效的方法；然而，这是一个非常困难的操作过程。EVT也可用于治疗颅内PCRRAs。EVT方法包括栓塞（支架或球囊辅助）和血流导向支架（或栓塞辅助）。对于难以治疗的复杂PCRRAs可选择搭桥手术。总体而言，经过适当治疗后，大多数颅内PCRRAs可实现高闭塞率和良好预后。
