Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results.
Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results.
复制标题
使用三维线圈对颅内宽颈动脉瘤进行血管内治疗：即时解剖和临床结果的预测因素。
DOI：
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复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
S. Bracard
中科院分区：
文献类型：
--
作者：
J. Vallée;L. Pierot;A. Bonafe;F. Turjman;P. Flandroy;J. Berge;G. Rodesch;S. Bracard
背景和目的
宽颈动脉瘤是弹簧圈血管内治疗的持续挑战。我们的目的是评价使用三维（3D）弹簧圈治疗颅内宽颈动脉瘤的直接解剖学和临床结果。
方法
在2年期间，8家参与中心的157例患者的160个动脉瘤（116个瘤颈≤ 4 mm，A组; 44个瘤颈> 4 mm，B组）接受了连续治疗。该手术包括首先用一个或多个3D球形弹簧圈将动脉瘤框起来，然后用螺旋弹簧圈填充。结果用单因素分析进行评价。多变量分析用于确定这些结果的独立预测因素。
结果
A组和B组分别有84个（72%）和30个（68%）动脉瘤的血管造影完全闭塞。这两组的平均容积闭塞百分比分别为30.9%和29.2%。A组围手术期发病率和死亡率分别为4%，B组分别为2%。两组之间没有观察到显著差异。然而，容积闭塞百分比与小于1.5的囊颈比（P = 0.061）和囊大小（P = 0.002）相关，除非每个动脉瘤使用3个或更多3D弹簧圈（P = 0.222）。容积闭塞百分比越高，血管造影闭塞程度越高（P = 0.004）。容积闭塞百分比是血管造影完全闭塞的独立预测因素（P = 0.001）。世界神经外科医生联合会蛛网膜下腔出血分级5级是围手术期死亡率的独立预测因素（P = 0.043）。
结论
在治疗时，三维弹簧圈被证明可用于改善瘤颈大于4 mm的动脉瘤的弹簧圈填塞以及血管造影和容积闭塞，前提是囊颈比≥ 1.5，并且首先定位最大数量的3D弹簧圈。
BACKGROUND AND PURPOSE
Aneurysms with a wide neck constitute a persistent challenge for endovascular therapy with coils. Our purpose was to evaluate the immediate anatomic and clinical results of treating intracranial wide-necked aneurysms by using three-dimensional (3D) coils.
METHODS
During a 2-year period, 160 aneurysms (116 with a neck < or = 4 mm, group A; 44 with a neck > 4 mm, group B) in 157 patients in eight participating centers were consecutively treated. The procedure consisted first of framing the aneurysm with one or more 3D spherical coils and then filling it with helical coils. Results were evaluated with univariate analysis. Multivariate analysis was used to identify independent predictors of these results.
RESULTS
Angiographic occlusion was complete in 84 (72%) and 30 (68%) aneurysms in groups A and B, respectively. Mean percentage of volumic occlusion in these groups was 30.9% and 29.2%, respectively. Perioperative morbidity and mortality rates were 4%, respectively, in group A and 2%, respectively, in group B. No significant difference between the two groups was observed. However, percentage of volumic occlusion correlated with sac-to-neck ratio less than 1.5 (P =.061) and with sac size (P =.002) except when three or more 3D coils per aneurysm were used (P =.222). The better the percentage of volumic occlusion, the better the degree of angiographic occlusion (P =.004). Percentage of volumic occlusion was an independent predictor of angiographic complete occlusion (P =.001). World Federation of Neurological Surgeons subarachnoid hemorrhage scale grade 5 was an independent predictor of perioperative mortality (P =.043).
CONCLUSION
Three-dimensional coils proved to be useful for improving coil packing and angiographic and volumic occlusion of aneurysms with a neck greater than 4 mm, at the time of treatment, provided the sac-to-neck ratio was 1.5 or greater, and the largest number of 3D coils were first positioned.
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：
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发表时间：
1994
期刊：
AJNR. American journal of neuroradiology
影响因子：
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作者：
FernandezZubillaga,A;Guglielmi,G;Viñuela,F;Duckwiler,GR
通讯作者：
Duckwiler,GR