Brown Ethan D L, Bassett Jared B, McCann Ryan, Turpin Justin, Mehta Shyle H, Werner Cassidy, Link Thomas, Teron Ina, Shah Kevin, Dehdashti Amir R, Patsalides Athos, Woo Henry, White Timothy G
Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA.
Interv Neuroradiol. 2025 Sep 9:15910199251375531. doi: 10.1177/15910199251375531.
BackgroundEndovascular coil embolization is a common treatment for intracranial aneurysms, but aneurysm recanalization remains a significant problem that may necessitate retreatment. This study aimed to identify patient, aneurysm, and procedural factors associated with recanalization in aneurysms treated exclusively with coil embolization.MethodsThis single center retrospective study assessed intracranial aneurysms treated with coiling-only between 2017 and 2022. Follow-up imaging was reviewed for recanalization with occlusion status graded via a modified Raymond-Roy classification. Univariate analysis assessed the association of clinical, morphological, and procedural factors with clinical complication, aneurysm occlusion, and recanalization status. Stepwise multivariable logistic regression was performed to identify independent predictors of aneurysm recanalization.ResultsOf 163 initially treated aneurysms, 142 were analyzed in complete case analysis for clinical outcomes. Complications occurred in 8 patients and were associated with larger aneurysm neck sizes (3.83 mm vs. 2.92 mm, p = 0.024), increased incidence of coil herniation (63% vs. 10%, p = 0.001), and greater number of coils used per aneurysm (7.13 coils vs. 4.64 coils, p = 0.028). Follow-up angiography in 122 aneurysms showed adequate occlusion in 116 (95.1%) and recanalization in 11.5%. Recanalization was more frequent in aneurysms that had larger initial volumes and in those without balloon inflation during coil deployment (both p < 0.05). On multivariable analysis, balloon inflation during coil deployment was the only independent predictor of aneurysm recanalization (OR 0.18; 95% CI 0.05-0.69; p = 0.009).DiscussionIn this single-center cohort of coiling-only treated aneurysms, the use of the balloon remodeling technique was strongly associated with durable aneurysm occlusion, reducing the odds of aneurysm recanalization. These findings support the routine use of balloon assistance in wide-neck and large aneurysms to achieve complete, stable occlusion and reduce the need for retreatment.
背景
血管内弹簧圈栓塞术是治疗颅内动脉瘤的常用方法，但动脉瘤再通仍是一个重大问题，可能需要再次治疗。本研究旨在确定单纯采用弹簧圈栓塞治疗的动脉瘤再通相关的患者、动脉瘤和手术因素。
方法
这项单中心回顾性研究评估了2017年至2022年间仅采用弹簧圈栓塞治疗的颅内动脉瘤。复查随访影像以评估再通情况，并通过改良的Raymond-Roy分级对闭塞状态进行分级。单因素分析评估临床、形态学和手术因素与临床并发症、动脉瘤闭塞和再通状态之间的关联。进行逐步多变量逻辑回归以确定动脉瘤再通的独立预测因素。
结果
在163个最初治疗的动脉瘤中，142个在完整病例分析中用于临床结局分析。8例患者出现并发症，并发症与较大的动脉瘤颈尺寸（3.83 mm对2.92 mm，p = 0.024）、弹簧圈疝出发生率增加（63%对10%，p = 0.001）以及每个动脉瘤使用的弹簧圈数量较多（7.13个弹簧圈对4.64个弹簧圈，p = 0.028）相关。122个动脉瘤的随访血管造影显示，116个（95.1%）闭塞良好，11.5%发生再通。初始体积较大的动脉瘤以及在弹簧圈置入过程中未进行球囊扩张的动脉瘤再通更频繁（均p < 0.05）。多变量分析显示，弹簧圈置入过程中进行球囊扩张是动脉瘤再通的唯一独立预测因素（OR 0.18；95% CI 0.05 - 0.69；p = 0.009）。
讨论
在这个仅采用弹簧圈治疗的单中心队列中，球囊重塑技术的使用与持久的动脉瘤闭塞密切相关，降低了动脉瘤再通的几率。这些发现支持在宽颈和大型动脉瘤中常规使用球囊辅助，以实现完全、稳定的闭塞并减少再次治疗的需求。
