Management of Residual and Recurrent Aneurysms After Initial Endovascular Treatment
Management of Residual and Recurrent Aneurysms After Initial Endovascular Treatment
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DOI：
10.1227/neu.0b013e3182350da5
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发表时间：
2012-03-01
期刊：
影响因子：
4.8
通讯作者：
Knosp, Engelbert
中科院分区：
文献类型：
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作者：
Dorfer, Christian;Gruber, Andreas;Knosp, Engelbert
背景技术背景：弹簧圈不稳定可能导致更高的延迟再出血率，这仍然是脑动脉瘤血管内治疗的一个问题。目的：报告127例血管内动脉瘤残余物患者，他们在18年的时间内接受了再治疗。方法：动脉瘤残留>原始病变20%、瘤颈残留不稳定、瘤样再生长的患者，结果：75例（59.1%）动脉瘤残余物经进一步再栓塞治疗。65例采用标准弹簧圈栓塞，9例采用支架保护弹簧圈栓塞，1例采用球囊重塑弹簧圈栓塞。手术治疗了52例（40.9%）囊性残留物。44例采用标准显微外科夹闭术，5例在旁路保护下闭塞或夹闭载瘤动脉，2例故意夹闭基底动脉主干，1例动脉瘤包裹术。动脉瘤复发的机制是93例弹簧圈压实和34例再生长。单次再栓塞足以闭塞78.7%的复发弹簧圈压实，但只有14.3%的复发动脉瘤regrowth.CONCLUSION：个性化的方法导致完全闭塞114个动脉瘤（89.7%），与颈部残留和残余动脉瘤检测11（8.7%）和2（1.6%）的情况下，分别。治疗发病率为11.9%，手术（15.6%）和血管内（9.3%）患者之间无显著差异（P = 0.09）。弹簧圈压实导致的复发可通过再栓塞安全治疗，而血管瘤再生导致的复发在技术可行时最好通过手术治疗。
BACKGROUND: Coil instability possibly translating into higher delayed rebleeding rates remains a concern in the endovascular management of cerebral aneurysms.OBJECTIVE: To report on 127 patients with endovascular aneurysmal remnants who underwent re-treatment over an 18 year period.METHODS: Patients presenting with aneurysm residuals >20% of the original lesion, unstable neck remnants, aneurysmal regrowth, or new aneurysmal daughter sacs were treated by an individualized approach, using both endovascular and surgical techniques.RESULTS: Seventy-five aneurysmal remnants (59.1%) were treated by further re-embolization. Standard coil embolization was used in 65 cases, stent-protected coiling in 9 cases, and balloon remodeled coiling in 1 case, respectively. Fifty-two (40.9%) aneurysmal remnants were treated surgically. Standard microsurgical clipping was used in 44 patients, parent artery occlusion or trapping under bypass protection in 5 cases, deliberate clipping of the basilar artery trunk in 2 cases, and aneurysm wrapping in one case, respectively. Mechanisms of aneurysm recurrence were coil compaction in 93 cases and regrowth in 34 cases. A single reembolization was sufficient to occlude 78.7% of recurrences from coil compaction, but only 14.3% of recurrences from aneurysm regrowth.CONCLUSION: The individualized approach resulted in complete occlusion of 114 aneurysms (89.7%), with neck remnants and residual aneurysms detectable in 11 (8.7%) and 2 (1.6%) cases, respectively. Treatment morbidity was 11.9%, without significant differences between surgical (15.6%) and endovascular (9.3%) patients (P = .09). Recurrences from coil compaction were safely treated by re-embolization, whereas recurrences from aneurysmal regrowth may best be managed surgically when technically feasible.