Nichols D A, Brown R D, Thielen K R, Meyer F B, Atkinson J L, Piepgras D G
Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Neurosurg. 1997 Sep;87(3):374-80. doi: 10.3171/jns.1997.87.3.0374.
The authors report their experience using electrolytically detachable coils for the treatment of ruptured posterior circulation aneurysms. Twenty-six patients with 28 posterior circulation aneurysms were treated. All patients were referred for endovascular treatment by experienced vascular neurosurgeons. Patients underwent follow-up angiography immediately after treatment, 1 to 6 weeks posttreatment, and 6 months posttreatment. Six-month follow-up angiograms obtained in 19 patients with 20 aneurysms demonstrated that 18 (90%) of the 20 aneurysms were 99 to 100% occluded, one aneurysm (5%) was approximately 90% occluded, and one aneurysm (5%) was approximately 75% occluded. The patient with the aneurysm that was approximately 75% occluded needed additional treatment, consisting of parent artery balloon occlusion, and was considered a treatment failure (3.8% of patients). There was one treatment-associated mortality (3.8%) but no treatment-associated serious neurological or nonneurological morbidity in the patient group. There was no recurrent aneurysm rupture during treatment or during the mean 27-month follow-up period. Endovascular treatment of ruptured posterior circulation aneurysms with electrolytically detachable coils can be accomplished with low morbidity and mortality rates. The primary goal of treatment--preventing recurrent aneurysm--can be achieved over the short term. Endovascular coil occlusion will play an important role in the treatment of ruptured posterior circulation aneurysms, particularly if long-term efficacy in preventing recurrent aneurysm hemorrhage can be documented.
作者报告了他们使用电解可脱卸弹簧圈治疗破裂性后循环动脉瘤的经验。对26例患者的28个后循环动脉瘤进行了治疗。所有患者均由经验丰富的血管神经外科医生转诊接受血管内治疗。患者在治疗后立即、治疗后1至6周以及治疗后6个月接受随访血管造影。19例患者的20个动脉瘤在6个月时的随访血管造影显示，20个动脉瘤中有18个（90%）闭塞率为99%至100%，1个动脉瘤（5%）闭塞率约为90%，1个动脉瘤（5%）闭塞率约为75%。闭塞率约为75%的动脉瘤患者需要额外治疗，包括对供血动脉进行球囊闭塞，该患者被视为治疗失败（占患者的3.8%）。患者组中有1例与治疗相关的死亡（3.8%），但无与治疗相关的严重神经或非神经并发症。在治疗期间或平均27个月的随访期内，均未发生动脉瘤再次破裂。使用电解可脱卸弹簧圈对破裂性后循环动脉瘤进行血管内治疗，可实现较低的发病率和死亡率。治疗的主要目标——预防动脉瘤复发——可在短期内实现。血管内弹簧圈闭塞将在破裂性后循环动脉瘤的治疗中发挥重要作用，特别是如果能证明其在预防动脉瘤复发出血方面的长期疗效。
