A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report.
A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report.
复制标题
弹簧圈栓塞术后复发性动脉瘤的手术陷阱及其组织学观察：技术病例报告。
作者：
Kazuo Mizoi;Takashi Yoshimoto;Akira Takahashi;Yoshihide Nagamine
目标和重要性
该病例报告详细描述了弹簧圈栓塞后治疗复发性动脉瘤时遇到的意外手术困难，并介绍了切除动脉瘤的组织学结果。这仅是第二例报告的人类弹簧圈栓塞后动脉瘤的组织学描述病例。
临床表现
一位60岁的女性经历了3个月的慢性头痛史。神经影像学研究显示2厘米的前交通动脉瘤。采用两阶段血管内弹簧圈栓塞术治疗动脉瘤，导致动脉瘤几乎完全闭塞。6个月随访时的脑血管造影显示动脉瘤轻微再充盈，18个月时的血管造影显示小残留物尺寸显著增加。因此，患者被转诊接受动脉瘤直接手术修复。
干预
在临时动脉夹闭下切除了被弹簧圈和血栓填塞的远端动脉瘤圆顶。由于动脉瘤壁发生内膜夹层，延伸至传入和传出动脉的开口，因此需要进行动脉瘤内动脉内膜切除术。然后用多个夹子闭塞动脉瘤，重建通畅的血管腔。然而，患者从手术中醒来，出现左侧轻偏瘫。术后血管造影显示右大脑前动脉闭塞。血栓形成动脉瘤的组织学研究表明，血栓的管腔表面没有内皮细胞。
结论
该病例不仅证明了弹簧圈栓塞治疗宽颈动脉瘤的疗效有限，而且还证明了直接手术修复此类复发动脉瘤的潜在困难。
OBJECTIVE AND IMPORTANCE
This case report details the unexpected surgical difficulty encountered in treating a recurrent aneurysm after coil embolization and presents the histological findings of the resected aneurysm. This is only the second reported case of histological description of an aneurysm after coil embolization in a human.
CLINICAL PRESENTATION
A 60-year-old woman experienced a 3-month history of chronic headache. Neuroimaging studies demonstrated a 2-cm anterior communicating artery aneurysm. The aneurysm was treated with a two-stage endovascular coil embolization, resulting in almost complete occlusion of the aneurysm. A cerebral angiogram at 6-month follow-up demonstrated slight refilling of the aneurysm, and angiography at 18 months showed a marked increase in the size of the small remnant. Therefore, the patient was referred for direct surgical repair of the aneurysm.
INTERVENTION
The distal aneurysm dome, which had been packed with the coils and thrombus, was resected under temporary arterial trapping. An intra-aneurysmal endarterectomy was required, because the aneurysm wall developed intimal dissection that extended to the orifices of afferent and efferent arteries. The aneurysm was then obliterated with multiple clips, reconstructing the patent vessel lumen. However, the patient awoke from surgery with left hemiparesis. A postoperative angiogram disclosed occlusion of the right anterior cerebral artery. An histological study of the thrombosed aneurysm showed that the luminal surface of thrombus was not lined by endothelium.
CONCLUSION
This case demonstrated not only the limited efficacy of coil embolization treatment for wide-necked aneurysms but also the potential difficulty in the direct surgical repair for such recurrent aneurysms.
影响因子：
4.1
作者：
GUGLIELMI, G;VINUELA, F;SEPETKA, I
通讯作者：
SEPETKA, I
电可脱线圈颅内动脉瘤的血管内闭塞：动脉瘤颈大小与治疗结果的相关性。
DOI：
--
发表时间：
1994
期刊：
AJNR. American journal of neuroradiology
影响因子：
--
作者：
FernandezZubillaga,A;Guglielmi,G;Viñuela,F;Duckwiler,GR
通讯作者：
Duckwiler,GR