Nogami Kenshu, Misaki Kouichi, Tsutsui Taishi, Nambu Iku, Kamide Tomoya, Nakada Mitsutoshi
Department of Neurosurgery, Kanazawa University, Kanazawa, Japan.
Surg Neurol Int. 2023 Feb 10;14:53. doi: 10.25259/SNI_1100_2022. eCollection 2023.
In coil embolization, a high volume embolization ratio prevents recanalization that may require retreatment. However, patients with a high volume embolization ratio may also require retreatment. Patients with inadequate framing with the first coil may experience recanalization of the aneurysm. We analyzed the relationship between embolization ratio of the first coil and recanalization requiring retreatment.
We reviewed data from 181 patients with unruptured cerebral aneurysms who underwent initial coil embolization between 2011 and 2021. We retrospectively analyzed the correlation between neck width, maximum aneurysm size, width, aneurysm volume, volume embolization ratio of the framing coil (first volume embolization ratio [1 VER]), and final volume embolization ratio (final VER) of cerebral aneurysms in patients and their retreatment.
Recanalization requiring retreatment was observed in 13 patients (7.2%). The factors related to recanalization were neck width, maximum aneurysm size, width, aneurysm volume, and 1 VER, but not the final VER. Multivariate analysis of the five factors showed a significant difference in the 1 VER ( = 0.002). The cutoff value for recanalization was a 1 VER of 5.8%. There were 162 cases with a VER ≥ 20% or higher, and the same analysis yielded similar results.
The 1 VER was significantly correlated with recanalization of cerebral aneurysms requiring retreatment. In coil embolization of unruptured cerebral aneurysms, it is important to achieve an embolization rate of at least 5.8% using a framing coil to prevent recanalization.
在弹簧圈栓塞治疗中，高栓塞率可防止再通，而再通可能需要再次治疗。然而，栓塞率高的患者也可能需要再次治疗。首次使用弹簧圈时成篮不充分的患者可能会出现动脉瘤再通。我们分析了首个弹簧圈的栓塞率与需要再次治疗的再通之间的关系。
我们回顾了2011年至2021年间181例未破裂脑动脉瘤患者接受首次弹簧圈栓塞治疗的数据。我们回顾性分析了患者脑动脉瘤的颈部宽度、最大动脉瘤大小、宽度、动脉瘤体积、成篮弹簧圈的体积栓塞率（首个体积栓塞率[1 VER]）和最终体积栓塞率（最终VER）与其再次治疗之间的相关性。
13例患者（7.2%）出现需要再次治疗的再通。与再通相关的因素有颈部宽度、最大动脉瘤大小、宽度、动脉瘤体积和1 VER，但与最终VER无关。对这五个因素进行多变量分析显示1 VER存在显著差异（=0.002）。再通的临界值是1 VER为5.8%。有162例患者的VER≥20%或更高，同样的分析得出了类似结果。
1 VER与需要再次治疗的脑动脉瘤再通显著相关。在未破裂脑动脉瘤的弹簧圈栓塞治疗中，使用成篮弹簧圈实现至少5.8%的栓塞率对于预防再通很重要。
