使用 Guglielmi 可脱性弹簧圈治疗脑动脉瘤的选择：伊利诺伊大学芝加哥分校的初步经验。
Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience.
作者信息
Debrun G M, Aletich V A, Kehrli P, Misra M, Ausman J I, Charbel F
机构信息
Department of Radiology, University of Illinois at Chicago, 60612, USA.
出版信息
Neurosurgery. 1998 Dec;43(6):1281-95; discussion 1296-7. doi: 10.1097/00006123-199812000-00011.
OBJECTIVE
We present our initial experience with Guglielmi detachable coils (GDCs). The aim of this study was to determine the criteria for aneurysms, ruptured or unruptured, that are suitable for this technique. The importance of aneurysm geometry and its impact on the final results are discussed.
METHODS
A retrospective analysis of 329 patients with 339 cerebral aneurysms that were treated at the University of Illinois Hospital at Chicago from May 1994 to June 1997 was conducted. One hundred eighty-five patients were treated surgically, and 144 were selected for treatment using GDCs. Of the 144 patients selected for GDC treatment, 55 patients with 55 aneurysms were admitted during the acute phase of subarachnoid hemorrhage and 89 patients with 97 aneurysms had nonruptured aneurysms or were treated after clinical recovery of previously ruptured aneurysms. All procedures were performed with the patients under general anesthesia and with systemic heparinization using live simultaneous biplane roadmapping, with the exception of the first four patients. These patients were treated before the installation of the biplane system. The percentage of aneurysm occlusion was determined at the end of each procedure. Follow-up angiography was scheduled to be performed at 6 months, 1 year, and 2 years after treatment.
PATIENT SELECTION
For the initial 25 patients (Group 1), selection for coiling was restricted to nonsurgical candidates or patients in whom coiling was thought to be the best treatment choice, based on medical condition and location of the aneurysm. The geometry of the aneurysm was not considered to be an important factor in the selection for coiling. The remaining patients (Group 2) were selected for coiling based on aneurysm geometry, as determined by pretherapeutic angiography. Aneurysms that were considered to be favorable for coiling included those that had a dome-to-neck ratio of at least 2 and an absolute neck diameter less than 5 mm.
RESULTS
The initial 25 patients (Group 1) were treated from May 1994 to February 1995. There were high morbidity and mortality rates, with 56% of the treated aneurysms occluded at 6 months. The remaining patients (Group 2) consisted of 119 patients with 123 aneurysms. There was no mortality directly related to the coiling procedure, and permanent morbidity was limited to 1.0%. Three patients (2.5%) developed transient neurological deficits secondary to the procedure, and seven patients (5.8%) experienced periprocedural complications that did not result in neurological sequelae. The morphological results were strongly correlated to the geometry of the aneurysms, with a complete occlusion rate of 72% among the acutely ruptured aneurysms and 80% among the nonacute aneurysms, when patients were selected for treatment based on the geometry of the aneurysms and the dome-to-neck ratio was at least 2. The occlusion rate dropped to 53% when selection was not based on aneurysm geometry and the dome-to-neck ratio was less than 2. A summary of the morphological outcomes for the Group 2 patients shows that 86% of the aneurysms that initially underwent coiling using GDCs were completely occluded (78% by coils alone, 3.0% in conjunction with surgery, and 5.0% with parent artery occlusion). Residual small neck remnants were present in 11% of the Group 2 aneurysms (3.0% were scheduled for surgical treatment of residual neck remnant growths not amenable to further endovascular treatment, and 8% were scheduled for initial 6-mo follow-up examinations). Death resulting from unrelated causes before initial follow-up occurred in 3.0% of the patients.
CONCLUSION
These preliminary results suggest that using GDCs is a safe technique resulting in low morbidity and mortality rates for the treatment of intracranial aneurysms in appropriately selected patients. The percentage of complete aneurysm occlusion is related to the density of coil packing, which is strongly dependent on the geometry of the aneurysm. Optim
目的
介绍我们使用 Guglielmi 可脱卸弹簧圈（GDC）的初步经验。本研究的目的是确定适合该技术的动脉瘤（破裂或未破裂）标准。讨论了动脉瘤几何形状的重要性及其对最终结果的影响。
方法
对 1994 年 5 月至 1997 年 6 月在芝加哥伊利诺伊大学医院接受治疗的 329 例患者的 339 个脑动脉瘤进行回顾性分析。185 例患者接受了手术治疗，144 例患者被选择使用 GDC 进行治疗。在 144 例被选择接受 GDC 治疗的患者中，55 例患有 55 个动脉瘤的患者在蛛网膜下腔出血急性期入院，89 例患有 97 个动脉瘤的患者患有未破裂动脉瘤或在先前破裂动脉瘤临床恢复后接受治疗。除前 4 例患者外，所有手术均在全身麻醉和全身肝素化下进行，并使用实时双平面路线图。这 4 例患者在双平面系统安装之前接受了治疗。在每个手术结束时确定动脉瘤闭塞的百分比。计划在治疗后 6 个月、1 年和 2 年进行随访血管造影。
患者选择
对于最初的 25 例患者（第 1 组），基于动脉瘤的病情和位置，选择进行弹簧圈栓塞仅限于非手术候选者或认为弹簧圈栓塞是最佳治疗选择的患者。动脉瘤的几何形状在选择弹簧圈栓塞时不被视为重要因素。其余患者（第 2 组）根据治疗前血管造影确定的动脉瘤几何形状选择进行弹簧圈栓塞。被认为适合弹簧圈栓塞的动脉瘤包括那些瘤顶与瘤颈比至少为 2 且绝对瘤颈直径小于 5mm 的动脉瘤。
结果
最初的 25 例患者（第 1 组）于 1994 年 5 月至 1995 年 2 月接受治疗。发病率和死亡率较高，6 个月时治疗的动脉瘤中有 56%闭塞。其余患者（第 2 组）包括 119 例患者的 123 个动脉瘤。没有与弹簧圈栓塞手术直接相关的死亡，永久性致残率限于 1.0%。3 例患者（2.5%）因手术继发短暂性神经功能缺损，7 例患者（5.8%）经历了围手术期并发症但未导致神经后遗症。形态学结果与动脉瘤的几何形状密切相关，当根据动脉瘤的几何形状选择患者且瘤顶与瘤颈比至少为 2 时，急性破裂动脉瘤的完全闭塞率为 72%，非急性动脉瘤为 80%。当选择不基于动脉瘤几何形状且瘤顶与瘤颈比小于 2 时，闭塞率降至 53%。第 2 组患者形态学结果总结表明，最初使用 GDC 进行弹簧圈栓塞的动脉瘤中有 86%完全闭塞（仅弹簧圈闭塞 78%，联合手术闭塞 3.0%，闭塞载瘤动脉闭塞 5.0%）。第 2 组动脉瘤中有 11%存在残留小瘤颈（3.0%计划对不适合进一步血管内治疗的残留瘤颈生长进行手术治疗，8%计划进行初始 6 个月随访检查）。在初始随访前因无关原因死亡的患者占 3.0%。
结论
这些初步结果表明，对于适当选择的患者，使用 GDC 是一种安全的技术，治疗颅内动脉瘤的发病率和死亡率较低。动脉瘤完全闭塞的百分比与弹簧圈填充密度有关，而弹簧圈填充密度很大程度上取决于动脉瘤的几何形状。最佳……
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