Malisch T W, Guglielmi G, Viñuela F, Duckwiler G, Gobin Y P, Martin N A, Frazee J G
Department of Neurosurgery, University of California School of Medicine, Los Angeles, USA.
J Neurosurg. 1997 Aug;87(2):176-83. doi: 10.3171/jns.1997.87.2.0176.
A prospective study was designed to evaluate clinical outcome in a series of 100 consecutively treated patients who underwent endovascular embolization of 104 intracranial aneurysms using Guglielmi detachable coils (GDCs). Midterm clinical outcome (2-6 years, average 3.5 years) was obtained for 94 patients and was classified according to a modified Glasgow Outcome Scale. Of nine patients treated in the acute phase of severe subarachnoid hemorrhage (Grade IV or V), seven died from the initial hemorrhage, one had a poor outcome, and one had a fair midterm outcome, with no post-GDC embolization hemorrhages. Twenty patients underwent subsequent surgical or endovascular procedures that did not include the use of GDCs. These included aneurysm clipping in nine patients and parent vessel sacrifice in 11 patients. None of these 20 patients experienced post-GDC embolization hemorrhage. The postoperative midterm clinical outcomes of these 20 patients did not significantly differ from the outcomes of patients who underwent GDC embolization as their definitive treatment. Six patients died of unrelated causes prior to reaching the 2-year survival point, with no post-GDC embolization hemorrhage. The midterm outcomes of the remaining 61 patients who underwent GDC embolization as their definitive treatment were classified as excellent (46 patients [75%]), good (seven patients [11%]), fair (three patients [5%]), poor (one patient [2%]), or dead (four patients [7%]). All four patients died from giant lesions. At midterm follow up, the surviving 57 patients' neurological statuses were unchanged or improved in 54 cases and worsened in three cases. The midterm post-GDC embolization hemorrhage rate was 0% for small aneurysms, 4% (one case) for large aneurysms, and 33% (five cases) for giant lesions. The GDC procedure is a safe, effective, and reliable means of preventing aneurysm hemorrhage in patients with small and large intracranial aneurysms. Results, however, are less satisfactory in cases involving giant lesions. Further follow-up review is necessary to establish durability in the longer term. Patients with Grade IV or V subarachnoid hemorrhage in this series generally had poor outcomes even if the GDC procedure was successful in occluding the aneurysm.
一项前瞻性研究旨在评估100例连续接受治疗的患者的临床结局，这些患者使用 Guglielmi 可脱卸弹簧圈（GDC）对104个颅内动脉瘤进行了血管内栓塞治疗。94例患者获得了中期临床结局（2至6年，平均3.5年），并根据改良的格拉斯哥预后量表进行分类。在9例严重蛛网膜下腔出血急性期（IV级或V级）接受治疗的患者中，7例死于初始出血，1例预后不良，1例中期预后尚可，且未发生GDC栓塞后出血。20例患者随后接受了不包括使用GDC的手术或血管内手术。其中包括9例患者进行了动脉瘤夹闭术，11例患者进行了载瘤血管牺牲术。这20例患者均未发生GDC栓塞后出血。这20例患者的术后中期临床结局与接受GDC栓塞作为确定性治疗的患者的结局无显著差异。6例患者在达到2年生存点之前死于无关原因，未发生GDC栓塞后出血。其余61例接受GDC栓塞作为确定性治疗的患者的中期结局分为优（46例[75%]）、良（7例[11%]）、中（3例[5%]）、差（1例[2%]）或死亡（4例[7%]）。所有4例死亡患者均死于巨大动脉瘤。在中期随访时，存活的57例患者中，54例神经功能状态未改变或改善，3例恶化。小动脉瘤的GDC栓塞后中期出血率为0%，大动脉瘤为4%（1例），巨大动脉瘤为33%（5例）。GDC手术是预防大小颅内动脉瘤患者动脉瘤出血的一种安全、有效且可靠的方法。然而，对于巨大动脉瘤病例，结果不太令人满意。需要进一步的随访复查以确定长期的持久性。本系列中IV级或V级蛛网膜下腔出血的患者即使GDC手术成功闭塞了动脉瘤，通常预后也较差。
