Cognard C, Weill A, Castaings L, Rey A, Moret J
Department of Interventional Radiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Radiology. 1998 Feb;206(2):499-510. doi: 10.1148/radiology.206.2.9457205.
To determine the types of aneurysm that may be treated endovascularly with platinum detachable coils.
Two hundred eight patients with 236 intracranial berry aneurysms underwent endovascular coil embolization; 150 patients had subarachnoid hemorrhage at the time of presentation.
Treatment was performed in 182 patients with 203 (86%) aneurysms (86%). Follow-up angiograms were obtained at 3 months in 160 cases of aneurysm. A second procedure was performed in 18 (11%) of these cases, and a third was performed in one case. Final follow-up results in 152 aneurysms demonstrated total occlusion in 123 (81%) cases, subtotal occlusion in 26 (17%) cases, and incomplete occlusion in three (2%) cases. All patients with subtotally occluded aneurysm were scheduled for later angiographic follow-up and any indicated repeat treatment. Technique-related morbidity rate was 4% (seven patients with permanent neurologic deficits due to clotting). Technique-related mortality rate was 2% (perioperative rupture in two, hematoma due to urokinase perfusion in one, rebleeding of the initial hematoma after excessive uncontrolled anticoagulation in one). Rebleeding occurred in one patient after incomplete occlusion.
Endovascular coil embolization seems to be a reliable technique, with good anatomic and clinical results, that provides protection against rebleeding of ruptured aneurysms.
确定可用铂可脱卸弹簧圈进行血管内治疗的动脉瘤类型。
208例患有236个颅内浆果状动脉瘤的患者接受了血管内弹簧圈栓塞治疗；150例患者在就诊时发生蛛网膜下腔出血。
182例患者的203个（86%）动脉瘤接受了治疗。160例动脉瘤患者在3个月时进行了随访血管造影。其中18例（11%）进行了第二次手术，1例进行了第三次手术。152个动脉瘤的最终随访结果显示，123例（81%）完全闭塞，26例（17%）次全闭塞，3例（2%）不完全闭塞。所有次全闭塞动脉瘤患者均计划进行后续血管造影随访及任何必要的重复治疗。技术相关发病率为4%（7例因凝血导致永久性神经功能缺损）。技术相关死亡率为2%（2例围手术期破裂，1例因尿激酶灌注导致血肿，1例因过度抗凝失控后初始血肿再出血）。1例不完全闭塞患者发生再出血。
血管内弹簧圈栓塞似乎是一种可靠的技术，具有良好的解剖学和临床效果，可预防破裂动脉瘤再出血。
