Fuga Michiyasu, Ishibashi Toshihiro, Kan Issei, Aoki Ken, Tachi Rintaro, Irie Koreaki, Kato Naoki, Hataoka Shunsuke, Nagayama Gota, Sano Tohru, Tanaka Toshihide, Murayama Yuichi
From the Department of Neurosurgery (M.F., T.I., I.K., N.K., S.H., G.N., T.S., T.T., Y.M.), The Jikei University School of Medicine, Tokyo, Japan
From the Department of Neurosurgery (M.F., T.I., I.K., N.K., S.H., G.N., T.S., T.T., Y.M.), The Jikei University School of Medicine, Tokyo, Japan.
AJNR Am J Neuroradiol. 2025 Jun 3;46(6):1143-1151. doi: 10.3174/ajnr.A8671.
Second coiling for recanalized aneurysms can mitigate the risk of delayed rupture, though re-recanalization may still occur. However, factors associated with re-recanalization after second coiling for recanalized aneurysms have yet to be adequately investigated. The present study explored a large, multicenter data set accumulated over 20 years to identify factors associated with major re-recanalization after second coiling for recanalized aneurysms.
We retrospectively reviewed 188 consecutive aneurysms in 185 patients who underwent second coiling for saccular recanalized aneurysms at 3 institutions from January 2003 to December 2023. Patients were classified into 2 groups: with major re-recanalization (R group) and without major re-recanalization (NR group). To identify factors associated with major re-recanalization, clinical, anatomic, and procedural characteristics were compared between the 2 groups by multivariate logistic regression analysis and stepwise selection.
During follow-up (mean, 62.3 ± 51.2 months), 72 (38.3%) of the 188 recanalized aneurysms showed major re-recanalization. In univariate analysis, compared with the NR group, the R group showed significantly larger aneurysm size, neck size, and aneurysm volume at first coiling and lower rates of stent-assisted coiling, use of an intermediate catheter (IMC), and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis revealed neck size at first coiling (OR 1.18; 95% CI: 1.04-1.33) as an independent risk factor and stent-assisted coiling (OR 0.34; 95% CI: 0.15-0.79), use of an IMC (OR 0.35; 95% CI: 0.16-0.80), and complete occlusion at second coiling (OR 0.16; 95% CI: 0.033-0.70) as independent protective factors for major re-recanalization.
The main risk factor for major re-recanalization after second coiling of recanalized aneurysms was neck size at first coiling, and protective factors included stent-assisted coiling, use of an IMC, and complete occlusion at second coiling. Second coiling for recanalized aneurysms may reduce the risk of major re-recanalization by using a stent or IMC and achieving complete occlusion.
对再通动脉瘤进行二次栓塞可降低延迟破裂的风险，尽管仍可能发生再再通。然而，再通动脉瘤二次栓塞后与再再通相关的因素尚未得到充分研究。本研究探讨了20年间积累的一个大型多中心数据集，以确定再通动脉瘤二次栓塞后与主要再再通相关的因素。
我们回顾性分析了2003年1月至2023年12月期间在3家机构接受囊状再通动脉瘤二次栓塞的185例患者的188个连续动脉瘤。患者分为两组：发生主要再再通的患者（R组）和未发生主要再再通的患者（NR组）。为了确定与主要再再通相关的因素，通过多因素逻辑回归分析和逐步选择对两组患者的临床、解剖和手术特征进行了比较。
在随访期间（平均62.3±51.2个月），188个再通动脉瘤中的72个（38.3%）出现了主要再再通。在单因素分析中，与NR组相比，R组在首次栓塞时动脉瘤大小、瘤颈大小和动脉瘤体积明显更大，支架辅助栓塞、使用中间导管（IMC）以及二次栓塞时完全闭塞的发生率更低。逐步多因素逻辑回归分析显示，首次栓塞时的瘤颈大小（OR 1.18；95%CI：1.04-1.33）是主要再再通的独立危险因素，而支架辅助栓塞（OR 0.34；95%CI：0.15-0.79）、使用IMC（OR 0.35；95%CI：0.16-0.80）以及二次栓塞时完全闭塞（OR 0.16；95%CI：0.033-0.70）是主要再再通的独立保护因素。
再通动脉瘤二次栓塞后主要再再通的主要危险因素是首次栓塞时的瘤颈大小，保护因素包括支架辅助栓塞、使用IMC以及二次栓塞时完全闭塞。对再通动脉瘤进行二次栓塞可通过使用支架或IMC并实现完全闭塞来降低主要再再通的风险。
