Turjman F, Massoud T F, Sayre J, Viñuela F
Department of Radiology, Hôpital Neurologique, Lyon, France.
AJNR Am J Neuroradiol. 1998 Oct;19(9):1645-51.
Complete intracranial aneurysmal occlusion by endovascular techniques is required for successful treatment and is presumably influenced by several parameters. The purpose of this study was to investigate whether operator experience and angiographic characteristics of intracranial aneurysms correspond to the degree of endovascular occlusion in the period immediately after treatment with Guglielmi detachable coils (GDCs).
Pre- and posttreatment angiograms of 72 patients undergoing GDC treatment were reviewed retrospectively. The following angiographic characteristics of the aneurysms were evaluated: largest diameter of the sac, volume, neck size, shape, type, cerebrovascular site, surroundings, and likely direction of aneurysmal inflow as judged by a score developed by measuring aneurysm/parent artery angulation. The chronological sequence in which the aneurysms were treated was used as a measure of operator experience. A chi2-test was used to identify parameters that correlated with outcomes of total (100%) or partial (<100%) occlusion. A multivariate analysis was used to determine the factors most predictive of aneurysmal occlusion at therapy.
Parameters that correlated with the unsatisfactory result of partial occlusion were large aneurysmal diameter, volume, and neck size, more direct inflow (ie, increasingly obtuse aneurysm/parent artery angulation), and early chronological presentation in the series. The three factors most predictive of partial occlusion were large aneurysmal diameter, more direct inflow, and early chronological order of treatment.
Several morphologic features of aneurysms were identified to help predict the immediate outcome of occlusion with GDCs. This study underscores the existence of a steep learning curve associated with GDC use in treating aneurysms and the importance of operator experience in achieving optimal therapeutic results.
通过血管内技术实现颅内动脉瘤的完全闭塞是成功治疗的必要条件，且可能受多个参数影响。本研究的目的是调查在使用 Guglielmi 可脱卸弹簧圈（GDC）治疗后即刻，术者经验和颅内动脉瘤的血管造影特征是否与血管内闭塞程度相关。
回顾性分析 72 例行 GDC 治疗患者的治疗前后血管造影图像。评估动脉瘤的以下血管造影特征：瘤囊最大直径、体积、瘤颈大小、形状、类型、脑血管部位、周围情况，以及通过测量动脉瘤/载瘤动脉夹角得出的评分所判断的动脉瘤可能的流入方向。将动脉瘤治疗的时间顺序作为术者经验的衡量指标。采用卡方检验确定与完全（100%）或部分（<100%）闭塞结果相关的参数。采用多因素分析确定治疗时最能预测动脉瘤闭塞的因素。
与部分闭塞的不满意结果相关的参数包括动脉瘤直径大、体积大、瘤颈大、流入更直接（即动脉瘤/载瘤动脉夹角越来越钝）以及在该系列中较早的时间呈现。最能预测部分闭塞的三个因素是动脉瘤直径大、流入更直接以及治疗的时间顺序靠前。
确定了动脉瘤的几个形态学特征，有助于预测 GDC 闭塞的即刻结果。本研究强调了在使用 GDC 治疗动脉瘤时存在陡峭的学习曲线，以及术者经验对于取得最佳治疗效果的重要性。
