Bavinzski G, Richling B, Gruber A, Killer M, Levy D
Department of Neurosurgery, University of Vienna Medical School, Austria.
Acta Neurochir (Wien). 1995;134(3-4):184-9. doi: 10.1007/BF01417687.
Thirteen patients with basilar artery bifurcation aneurysms, treated by electrothrombosis using electrically detachable coils, are presented. Nine of them presented after hemorrhage, two with mass effect, and two were found coincidentally with other ruptured aneurysms. Selection for endovascular therapy was based on the following criteria: 1) poor clinical condition (Hunt and Hess III-V); 2) high surgical risk; 3) age and poor medical condition; 4) morphological features (small necked aneurysms). With endovascular Guglielmi detachable coils aneurysm occlusion ranging from 70-100% was achieved in all cases. All five small necked and two large broad necked aneurysms were totally occluded. Two large aneurysms had a 95% occlusion and two other large aneurysms were 90% occluded. In another patient with a large broad based aneurysm only an 80% occlusion was achieved, because of tortuosity of the vertebrobasilar system. Our last patient, who presented as grade V clinically, was partially treated with a 70% aneurysmal occlusion. The clinical results were excellent in 10 and good in 2. The only poor outcome was seen in the grade V patient. There was no morbidity or mortality related to therapy. The only complication was an asymptomatic dissecting aneurysm at the origin of the vertebral artery. Angiographic follow up time ranged from 6 to 20 months with a mean of 9 months. Four patients were treated too recently to have their angiographic follow up at 6 months. Two patients were lost to follow up. Clinical follow up ranged from 1 to 17 months with a mean of 8.9 months. The analysis of our cases clearly shows that aneurysms, which were densely packed with coils, especially if small necked, were less likely to be reperfused and showed a longlasting stable result. Large broad based aneurysms were more likely to be reopened by blood flow after the first procedure, especially if loosely filled with coils, and needed up to 3 interventions to achieve a satisfying result, whereas later in the series a high percentage rate of occlusion was seen after the first procedure. We consider now also a less than 100% occlusion acceptable, because most of the aneurysms will rupture at the dome, which was occluded in all our cases. We conclude, that this new endovascular method is a viable alternative in the treatment of posterior circulation aneurysms with a high surgical risk, in old patients and those in poor clinical and medical condition.
本文介绍了13例基底动脉分叉部动脉瘤患者，采用电可脱性弹簧圈进行电血栓形成治疗。其中9例在出血后就诊，2例有占位效应，2例与其他破裂动脉瘤同时发现。血管内治疗的选择基于以下标准：1）临床状况差（Hunt和Hess III - V级）；2）手术风险高；3）年龄大且身体状况差；4）形态学特征（颈部小的动脉瘤）。使用血管内Guglielmi可脱性弹簧圈，所有病例的动脉瘤闭塞率在70% - 100%之间。所有5例颈部小的动脉瘤和2例大的宽颈动脉瘤完全闭塞。2例大动脉瘤闭塞率为95%，另外2例大动脉瘤闭塞率为90%。在另一例宽基底大动脉瘤患者中，由于椎基底系统迂曲，仅实现了80%的闭塞。我们的最后一例患者临床分级为V级，接受部分治疗，动脉瘤闭塞率为70%。临床结果10例优，2例良。唯一的不良结果出现在V级患者中。没有与治疗相关的发病率或死亡率。唯一的并发症是椎动脉起始处无症状的夹层动脉瘤。血管造影随访时间为6至20个月，平均9个月。4例患者治疗时间过近，6个月时未进行血管造影随访。2例患者失访。临床随访时间为1至17个月，平均8.9个月。对我们病例的分析清楚地表明，用弹簧圈紧密填塞的动脉瘤，尤其是颈部小的动脉瘤，再通的可能性较小，且显示出长期稳定的结果。宽基底大动脉瘤在首次手术后更有可能因血流重新开放，尤其是如果弹簧圈填塞松散，需要多达3次干预才能获得满意结果，而在该系列后期，首次手术后可见高闭塞率。我们现在也认为闭塞率低于100%是可以接受的，因为大多数动脉瘤将在瘤顶破裂，而在我们所有病例中瘤顶均已闭塞。我们得出结论，这种新的血管内方法是治疗手术风险高、老年患者以及临床和身体状况差的患者后循环动脉瘤的一种可行替代方法。
