Kuether T A, Nesbit G M, Barnwell S L
Department of Neurosurgery, Oregon Health Sciences University, Portland, 97201-3098, USA.
Neurosurgery. 1998 Nov;43(5):1016-25. doi: 10.1097/00006123-199811000-00007.
The purpose of this report is to provide the most detailed treatment and outcome data currently available in the literature, to allow for the further evaluation of Guglielmi detachable coils (GDC) as an appropriate treatment option for patients with cerebral aneurysms.
During a period of 4.5 years, 74 patients with intracerebral aneurysms were treated with GDC in the Department of Neurosurgery at Oregon Health Sciences University. A comprehensive retrospective and prospective analysis of these patients was performed, to assess the overall angiographic and clinical outcomes for these patients.
Seventy-seven aneurysms were treated, with an average angiographic follow-up period of 1.4 years. Initially, 40% of aneurysms exhibited complete (100%) occlusion, 52% near complete (90-99%) occlusion, and 8% incomplete (<90%) occlusion. The average clinical follow-up period was 2.2 years. For unruptured aneurysms, 85% of patients returned to independent status. Of patients of Hunt and Hess Grade I/II status, 81% were independent; of patients of Grade III status, 100% were independent; and, of patients of Grade IV/V status, 50% were independent. The procedure-related morbidity rate was 9.1%, with a 7.8% risk of death from aneurysm perforation, stroke, or delayed hemorrhage. No completely occluded aneurysm hemorrhaged after GDC treatment (follow-up period, 1.9 yr). Of near complete occlusions, 2.6% hemorrhaged after embolization, at a rate of 1.4%/yr (follow-up period, 1.9 yr).
This study details long-term clinical outcomes after GDC treatment and describes factors affecting the need for retreatment. Although complete anatomic cure was not obtained in all cases and the long-term protection from subarachnoid hemorrhage remains to be determined, these data indicate that GDC are a safe and efficacious treatment for cerebral aneurysms.
本报告旨在提供文献中目前可得的最详细的治疗及结果数据，以便进一步评估 Guglielmi 可脱卸弹簧圈（GDC）作为脑动脉瘤患者合适治疗选择的情况。
在 4.5 年的时间里，俄勒冈健康与科学大学神经外科对 74 例脑动脉瘤患者采用 GDC 进行治疗。对这些患者进行了全面的回顾性和前瞻性分析，以评估其总体血管造影和临床结果。
共治疗了 77 个动脉瘤，血管造影平均随访期为 1.4 年。最初，40%的动脉瘤显示完全（100%）闭塞，52%接近完全（90 - 99%）闭塞，8%不完全（<90%）闭塞。临床平均随访期为 2.2 年。对于未破裂动脉瘤，85%的患者恢复到独立状态。Hunt 和 Hess 分级为 I/II 级的患者中，81%为独立状态；III 级患者中，100%为独立状态；IV/V 级患者中，50%为独立状态。与手术相关的发病率为 9.1%，因动脉瘤穿孔、中风或延迟性出血导致的死亡风险为 7. Eight percent. GDC 治疗后，无完全闭塞的动脉瘤发生出血（随访期 1.9 年）。在接近完全闭塞的动脉瘤中，2.6%在栓塞后出血，出血率为 1.4%/年（随访期 1.9 年）。
本研究详细阐述了 GDC 治疗后的长期临床结果，并描述了影响再次治疗需求的因素。尽管并非所有病例都实现了完全解剖治愈，且蛛网膜下腔出血的长期预防效果仍有待确定，但这些数据表明 GDC 是治疗脑动脉瘤的一种安全有效的方法。
