Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome
Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome
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颅内动脉瘤在弹簧圈栓塞后随着时间的推移反复重新开放：影像学特征和治疗结果
DOI：
10.1007/s00234-006-0200-2
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发表时间：
2007
期刊：
影响因子：
2.8
通讯作者：
G. Beute
中科院分区：
文献类型：
--
作者：
W. J. V. Rooij;M. Sprengers;M. Sluzewski;G. Beute
简介我们报告了随着时间的推移反复重新打开并在 2-11 年随访期间盘绕 3 次或以上的动脉瘤患者的影像学和临床特征。方法在 1995 年至 2005 年间对 827 个盘绕动脉瘤中的 624 个进行血管造影随访时，74 个动脉瘤 (8.9%) 重新打开并另外盘绕。在长期随访期间，12 名患者的 12 个动脉瘤 (1.5%) 反复重新打开并反复盘绕。最初的动脉瘤尺寸范围为 15 至 30 毫米。四个动脉瘤含有腔内血栓。八个动脉瘤与蛛网膜下腔出血有关，两个与占位效应有关，还有两个是偶然发现的。动脉瘤的位置为基底动脉（8个）、颈动脉（2个）、前交通动脉（1个）和大脑中动脉（1个）。结果总共对12个动脉瘤进行了49次弹簧圈治疗，每个动脉瘤进行了3到6次弹簧圈治疗。在 49 次线圈治疗中，20 次（41%）使用支撑装置进行。没有手术并发症（0%，97.5% CI 0–5.7%）。平均临床随访期为 70.6 个月（中位数 60 个月，范围 25-135 个月）。所有 12 名患者的神经系统状况均良好 (GOS 5)。通过压实九个动脉瘤和通过将弹簧圈迁移到三个动脉瘤的腔内血栓中来重新打开。在两个动脉瘤中，晚期再生长在上次卷绕后 76 个月和 95 个月时变得明显。结论随着时间的推移重新张开并需要第二次卷绕的动脉瘤应定期进行成像，以检测重复的重新张开或再生长。定期随访、必要时追加治疗的治疗策略是有效且安全的。
IntroductionWe report imaging and clinical characteristics of patients with aneurysms that repeatedly reopened over time and were coiled three times or more during a follow-up period of 2–11 years.MethodsAt angiographic follow-up of 624 of 827 aneurysms coiled between 1995 and 2005, 74 aneurysms (8.9%) reopened and were additionally coiled. During an extended follow-up, 12 aneurysms (1.5%) in 12 patients repeatedly reopened and were repeatedly coiled. Initial aneurysm sizes ranged from 15 to 30 mm. Four aneurysms contained intraluminal thrombus. Eight aneurysms were associated with subarachnoid hemorrhage and two with a mass effect, and two were incidentally discovered. The locations of aneurysms were basilar artery (eight), carotid artery (two), anterior communicating artery (one) and middle cerebral artery (one).ResultsAltogether, 49 coil treatments were performed in the 12 aneurysms, ranging from three to six coil treatments per aneurysm. Of the 49 coil treatments, 20 (41%) were performed with a supporting device. There were no procedural complications (0%, 97.5% CI 0–5.7%). The mean clinical follow-up period was 70.6 months (median 60, range 25–135 months). All 12 patients are neurologically doing well (GOS 5). Reopening was by compaction in nine aneurysms and by migration of coils into intraluminal thrombus in three aneurysms. In two aneurysms, late regrowth became apparent at 76 and 95 months after the previous coiling.ConclusionAneurysms that reopen over time and need to be coiled for a second time should be imaged at regular intervals to detect repeated reopening or regrowth. The treatment strategy of regular follow-up and additional treatments when necessary is effective and safe.