Bae Jin Woo, Oh Han San, Hong Chang-Eui, Kim Kang Min, Yoo Dong Hyun, Kang Hyun-Seung, Cho Young Dae
Department of Neurosurgery, Inha University Hospital, Incheon, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Neuroradiol. 2024 Feb;51(1):59-65. doi: 10.1016/j.neurad.2023.05.006. Epub 2023 May 27.
In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability.
In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence.
During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (p=.003) and autosomal dominant polycystic kidney disease (ADPKD; p<.001). Stent implantation (p=.038) and successful occlusion at second coiling (p=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (p=.023). Procedure-related complications included asymptomatic thromboembolism (n = 9), transient ischemic neurologic deficits (n = 2), procedural bleeding (n = 1), and coil migration (n = 1), but there were no residual effects or deaths.
Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.
在血管内治疗时代，脑动脉瘤栓塞后再通的发生率越来越高。重复栓塞通常用于预防再出血，尽管再栓塞的长期疗效尚未得到充分研究。本研究旨在评估再通动脉瘤再栓塞的临床和影像学结果，重点关注手术安全性、有效性和持久性。
在这项回顾性研究中，我们检查了308例患者的310个复发性动脉瘤。一旦确定主要再通（初次弹簧圈栓塞后），所有病变均再次进行弹簧圈栓塞。然后对长期随访期间积累的病历和放射学数据进行回顾。采用Cox比例风险回归分析确定后续复发的危险因素。
在长时间随访（平均40.2±33.0个月）期间，87个动脉瘤（28.1%）再次出现主要再通。多变量Cox回归分析将再次再通与初始囊颈宽度（p=0.003）和常染色体显性多囊肾病（ADPKD；p<0.001）相关联。在这种情况下，支架植入（p=0.038）和第二次栓塞时成功闭塞（p=0.012）可预防后期再通。第二次栓塞进行得越晚，进一步复发的风险越低（p=0.023）。与手术相关的并发症包括无症状血栓栓塞（n=9）、短暂性缺血性神经功能缺损（n=2）、手术出血（n=1）和弹簧圈移位（n=1），但无残留影响或死亡。
重复弹簧圈栓塞是再通脑动脉瘤的一种安全治疗选择。宽颈状态和ADPKD是后续再通的风险因素，而成功闭塞和支架植入似乎可降低再栓塞术后复发的可能性。
