ENDOVASCULAR TREATMENT OF POSTERIOR CIRCULATION ANEURYSMS BY ELECTROTHROMBOSIS USING ELECTRICALLY DETACHABLE COILS
ENDOVASCULAR TREATMENT OF POSTERIOR CIRCULATION ANEURYSMS BY ELECTROTHROMBOSIS USING ELECTRICALLY DETACHABLE COILS
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DOI：
10.3171/jns.1992.77.4.0515
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发表时间：
1992-10-01
影响因子：
4.1
通讯作者：
SEPETKA, I
中科院分区：
文献类型：
--
作者：
GUGLIELMI, G;VINUELA, F;SEPETKA, I
在一项多中心研究中，120 名手术风险较高的颅内动脉瘤患者接受了电解可拆卸弹簧圈和血管内电血栓治疗。介绍了颅后窝动脉瘤患者（42 名患者，43 个动脉瘤）的治疗结果。最常见的临床表现是蛛网膜下腔出血（24 例）。临床随访期为1周至18个月。 16 个小颈动脉瘤中的 13 个实现了动脉瘤完全闭塞，26 个宽颈动脉瘤中的 4 个实现了动脉瘤完全闭塞。 26 个宽颈动脉瘤中的 22 个和 16 个小颈动脉瘤中的 3 个实现了 70% 至 98% 的动脉瘤血栓形成。由于技术并发症，一个动脉瘤无法得到治疗。两例患者需要对残余动脉瘤进行术后夹闭。一名患者（最初为 Hunt 和 Hess V 级）经历了动脉瘤的手术破裂，需要紧急载瘤动脉闭塞。 5天后他最终去世。另一名患者（最初为 IV 级）出现线圈移位和大脑后动脉区域缺血。第三名患者在宽颈基底动脉分叉动脉瘤完全闭塞后出现永久性神经功能缺损（偏盲）。一名患者患有无法手术的巨大基底动脉分叉动脉瘤，部分闭塞后 18 个月因动脉瘤出血死亡。与治疗相关的总体发病率和死亡率分别为 4.8%（两例）和 2.4%（一例）（如果仅考虑 Hunt 和 Hess I、II 和 III 级患者，则为 2.6% 和 0%）。建议该技术是治疗动脉瘤的可行替代方案。颅后窝动脉瘤患者的手术风险较高。需要更长时间的血管造影和临床随访研究来确定这种最近开发的血管内闭塞技术的长期疗效。必须对宽颈次全闭塞动脉瘤患者进行密切的术后血管造影和临床监测，以检查潜在的动脉瘤再通、再生长和破裂。
In a multicenter study, 120 patients with intracranial aneurysms presenting a high surgical risk were treated using electrolytically detachable coils and electrothrombosis via an endovascular approach. The results of treatment in patients with posterior fossa aneurysms (42 patients with 43 aneurysms) are presented. The most frequent clinical presentation was subarachnoid hemorrhage (24 cases). The clinical follow-up periods ranged from 1 week to 18 months. Complete aneurysm occlusion was obtained in 13 of 16 aneurysms with a small neck and in four of 26 wide-necked aneurysms. A 70% to 98% thrombosis of the aneurysm was achieved in 22 of 26 aneurysms with a wide neck and in three of 16 small-necked aneurysms. One aneurysm could not be treated due to a technical complication. Two cases required postprocedural surgical clipping of a residual aneurysm.One patient (originally in Hunt and Hess Grade V) experienced procedural rupture of the aneurysm requiring an emergency parent artery occlusion. He eventually died 5 days later. Another patient (originally in Grade IV) had coil migration and posterior cerebral artery territory ischemia, A third patient developed a permanent neurological deficit (hemianopsia) after complete occlusion of a wide-necked basilar bifurcation aneurysm. One patient, harboring an inoperable giant basilar bifurcation aneurysm, died from aneurysm bleeding 18 months after partial occlusion.Overall morbidity and mortality rates related to treatment were 4.8% (two cases) and 2.4% (one case), respectively (2.6% and 0% if considering only patients in Hunt and Hess Grades I, II, and III).It is suggested that this technique is a viable alternative in the management of patients with posterior fossa aneurysms associated with high surgical risk. Longer angiographic and clinical follow-up study is necessary to determine the long-term efficacy of this recently developed endovascular occlusion technique. Close postoperative angiographic and clinical monitoring of patients with wide-necked subtotally occluded aneurysms is mandatory to check for potential aneurysmal recanalization, regrowth, and rupture.