Late rebleeding of ruptured intracranial aneurysms treated with detachable coils

BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of late rebleeding of ruptured intracranial aneurysms treated with detachable coils. PATIENTS AND METHODS: A clinical follow-up study was conducted in 393 consecutive patients with a ruptured aneurysm treated with detachable coils between January 1995 and January 2003. Late rebleeding was defined as recurrent hemorrhage from a coiled aneurysm >1 month after coiling. One patient was lost to follow-up. Total clinical follow-up of the 392 patients who were coiled for ruptured cerebral aneurysms was 18,708 months (1559 patient years; median, 48 months; mean, 47.7 months; range, 0-120 months). RESULTS: Four patients suffered late rebleeding from the coiled aneurysm at 8, 12, 30, and 40 months after coiling, respectively. Two of these patients died. Another patient died of probable rebleeding 4 months after coiling. The incidence of late rebleeding was 1.27% (5/393) and mortality of late rebleeding was 0.76% (3/393). The annual late rebleeding rate was 0.32%, and the annual mortality rate from late rebleeding was 0.19%. During the follow-up period, 53 coiled aneurysms in 53 patients (13%) were additionally treated: 35 aneurysms (8.9%) were additionally treated with coils, 16 aneurysms (4.1%) were additionally clipped, and 2 aneurysms (0.5%) were additionally treated with parent vessel balloon occlusion. CONCLUSION: The late rebleeding rate after coiling of ruptured cerebral aneurysms is very low. Follow-up of patients with a coiled aneurysm is mandatory to identify aneurysms that need additional treatment after reopening.     

Surveillance of intracranial aneurysms treated with detachable coils: a comparison of MRA techniques

Two MRA techniques were evaluated for the follow-up of coiled intracranial aneurysms. Twenty-nine coiled aneurysms were evaluated for a total of 36 follow-up assessments using 3D time-of flight MRA (TOF MRA), an auto-triggered elliptic–centric-ordered three-dimensional gadolinium-enhanced MR angiogram (ATECO MRA), as well as a selective digital subtraction angiography (DSA), which served as the gold standard. Confident visualization was seen in 36 (100%) of ATECO MRAs and in 32 (89%) of the TOF MRAs. Eleven residual aneurysm components (RACs) greater than 2 mm were described on DSA. Of these, nine were seen on ATECO MRA (sensitivity of 81% and specificity of 88%) and four were seen on TOF MRA (sensitivity of 40% and specificity of 90%). The two RACs not seen on ATECO MRA both measured 3 mm. The six RACs not seen on TOF MRA measured 3, 4 and 5 mm. ATECO MRA provides a non-invasive reliable angiogram for the surveillance of coiled aneurysms and is superior to TOF MRA for this purpose.     

Histopathologic evaluation of aneurysms treated with Guglielmi detachable coils or matrix detachable microcoils

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the degree of organization and fibrocellular tissue development in aneurysms treated with bare platinum or biologically active microcoils. METHODS: Twelve aneurysms were removed at autopsy between 1-18 days and another 2 between 2-3 months posttreatment. Four aneurysms were surgically removed between 6 months and 3 years following treatment. One aneurysm removed at 8 days and another at 6 months were treated with bioactive (Matrix) coils; the other 16 with bare platinum (Guglielmi detachable coils; GDCs). All specimens were embedded in plastic, stained with hematoxilin-eosin and elastin and examined by light microscopy. RESULTS: All specimens removed within 3 weeks demonstrated intra-aneurysmal thrombus, without signs of organization or fibrotic tissue formation over the neck regardless of the type of coils used. In the GDC-treated aneurysms, evidence of early thrombus organization was observed within 2-3 months, and completed yet imperfect fibrocellular reaction together with residual thrombus at 2-3 years. In the Matrix-treated specimens, the aneurysm cavity was completely filled with granulation tissue corresponding to still ongoing fibrocellular reaction at 6 months, including newly formed blood vessels, smooth muscle cells, and collagen deposition without signs of residual thrombus. CONCLUSIONS: Our results indicate that in aneurysms treated with bare platinum coils thrombus organization does not occur until late after treatment and may remain imperfect for years. In one aneurysm studied 8 days following treatment with Matrix coils, no difference was noted compared to aneurysms treated with bare platinum coils. In another aneurysm examined 6 months following packing with Matrix coils, the histologic changes support the hypothesis that the biologically active polymer may accelerate aneurysm healing.     

单个弹簧圈栓塞颅内微小动脉瘤的单中心经验

目的探讨单个弹簧圈栓塞颅内微小动脉瘤(最大径<3 mm)的可行性和疗效。方法 2001年1月至2011年1月对72例颅内微小动脉瘤患者的77个动脉瘤进行单个弹簧圈栓塞,其中动脉瘤破裂出血52例,多发性动脉瘤13例。用3D-DSA选择工作角度测量动脉瘤大小(前后径、上下径、宽颈、最大径和瘤颈)。随访脑血管造影3～88个月(平均24.8个月)。结果对所有77个微小动脉瘤成功实施了单个弹簧圈栓塞,其中10个采用球囊辅助弹簧圈栓塞,19个联合支架辅助弹簧圈栓塞。术中破裂出血7例,发生脑栓塞事件2例,术中弹簧圈移位2例。术后即刻造影示完全栓塞42个,次全栓塞30个,部分栓塞5个。除2例死亡外,所有病例进行了至少2次复查(术后3和12个月),其中再通5个,对3个进行了再次栓塞,延迟性弹簧圈移位2例。12个月后复查造影示完全栓塞61个,次全栓塞14个。结论单个弹簧圈栓塞颅内微小动脉瘤可行、安全并有效,联合支架辅助治疗可以降低其再通率。     

Short-term outcome of intracranial aneurysms treated with polyglycolic acid/lactide copolymer-coated coils compared to historical controls treated with bare platinum coils: a single-center experience

BACKGROUND AND PURPOSE: Aneurysm recanalization is an innate problem in endovascular treatment of aneurysms with coils. A coated coil system, covered with a bioabsorbable polymeric material (polyglycolic acid/lactide copolymer, PGLA), was developed to accelerate intra-aneurysmal clot organization and fibrosis. The purpose of this study was to evaluate the efficacy and safety of the PGLA-coated coils in patients with intracranial aneurysms and to compare the outcome with that of bare platinum coils. PATIENTS AND TECHNIQUES: Fifty-one patients harboring 56 intracranial aneurysms underwent endovascular embolization with the PGLA-coated coils. In the control group were 78 consecutive patients, harboring 87 aneurysms, who underwent coil embolization with bare platinum coils. The authors compared coil volume, packing attenuation, degree of occlusion of aneurysms, procedure-related complications, and follow-up results between the 2 groups. RESULTS: The PGLA-coil group showed comparable data regarding rate of total or near-total occlusion of the aneurysm, incidence procedure-related thromboembolism, and management outcome. Mean coil volume deployed and packing attenuation of the PGLA-coil group were significantly higher than those of the bare-coil group (P = .0026 and P < .0001, respectively). Radiologic follow-up evaluation revealed recanalization in 14 of 39 aneurysms (major recanalization in 5 [13%] and minor recanalization in 9 [23%]) among the PGLA-coil group and in 29 of 64 aneurysms (major recanalization in 9 [14%] and minor recanalization in 20 [31%]) among the bare-coil group. CONCLUSION: In this study, the incidence of recanalization was not different in aneurysms treated with PGLA-coated coils compared with historical controls treated with bare platinum coils.     

A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils

BACKGROUND AND PURPOSE: The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the stability of anatomic occlusion of aneurysms treated with GDCs and assess the rate of recanalization and re-treatment. METHODS: A multicenter study involving 650 patients with 705 ruptured aneurysms treated with GDCs between January 1998 to May 2003 was conducted. During this period, 63% of ruptured aneurysms were treated by the endovascular technique. The morbidity and mortality associated with this technique, procedural feasibility, acute angiographic occlusion results, and long-term angiographic follow-up were assessed. RESULTS: Overall technical feasibility of GDC treatment was 96.9%. Upon admission, 25% of patients were Hunt and Hess grade IV or V. Acute angiographic results in 683 aneurysms demonstrated total occlusion in 496 cases (72.6%), subtotal occlusion in 171 cases (25.%), and incomplete occlusion in 16 cases (2.4%). All patients were controlled by angiography and MR imaging at 3 months, 1 year, and subsequent yearly examinations post-treatment. A second treatment was performed in 27 cases (recanalization, 4.7%). Long-term follow-up angiograms (mean, 36 months) were obtained in 571 aneurysms (95%). Of them, 422 aneurysms (73.9%) demonstrated complete occlusion, 148 aneurysms (25.9%) demonstrated subtotal occlusion, and only 1 aneurysm was incompletely occluded. Overall mortality was 11.4% for all patients, with procedural mortality evaluated at 1.4%. Overall morbidity was calculated at 8.6%. Only one rebleeding occurred in our study, with a second procedure performed without vital consequences for the patient. CONCLUSION: Our multicenter study confirms the stability of aneurysm embolization with GDC, with only 4.7% of aneurysms requiring re-treatment.     

电解可解脱弹簧圈栓塞颅内动脉瘤

目的　探讨电解可解脱弹簧圈治疗颅内动脉瘤的手术指征、术前评估方法、技术操作要点、手术时机、并发症防治、治疗效果、存在的问题及临床应用前景。方法　 72例患者 ,80枚颅内动脉瘤中 ,6 8例为破裂动脉瘤 ,4例为未破裂动脉瘤。动脉瘤部位在后交通动脉 2 0枚 ,前交通动脉 32枚 ,大脑中动脉 8枚 ,大脑后动脉 5枚 ,眼动脉 3枚 ,颈内动脉分叉处 3枚 ,基底动脉 5枚 ,小脑后下动脉 2枚 ,脉络膜前动脉 2枚。 72例患者中 ,Hunt Hess分级 :Ⅰ级 2 4例 ,Ⅱ级 2 5例 ,Ⅲ级 10例 ,Ⅳ级 9例 ,Ⅴ级 4例。72例患者分别采用单纯弹簧圈栓塞、血管内支架加弹簧圈栓塞、瘤颈重塑形技术栓塞和双导丝技术栓塞。蛛网膜下腔出血 (SAH)后 1周内治疗的患者 18例 ,2～ 3周内治疗的患者 2 9例 ,4周以后治疗的 2 1例。手术采用全麻并在术中适当控制血压 ,使收缩压不超过 110mmHg ,手术全程在DSA动态监视下完成。根据患者SAH的严重程度 ,采用术前或者术后给予脑室外引流、腰椎蛛网膜下腔引流或单纯腰椎穿刺释放血性脑脊液的方法 ,栓塞术后全部病例给予“3H”治疗。结果　动脉瘤完全闭塞 6 8枚 ,占 85 % ,栓塞程度 95 %～ 99%的 8枚 ,占 10 % ,栓塞程度达 90 %的 4个 ,占 5 %。全组死亡 2例 ,占 2 .78%。术中动脉瘤出血 2例 ,经弹簧     

Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital subtraction angiography

PURPOSE: To compare three-dimensional (3D) time-of-flight magnetic resonance (MR) angiography with digital subtraction angiography (DSA) in the follow-up of intracranial aneurysms treated with selective endovascular placement of detachable coils. MATERIALS AND METHODS: Sixty-eight consecutive patients with intracranial aneurysms were included in the prospective study. The goal was to evaluate 3D time-of-flight MR angiography versus DSA for the detection of a residual aneurysm neck or residual flow inside the coil mesh. RESULTS: Eighty-one MR angiographic and 83 DSA examinations were performed; 15 patients were examined with both modalities twice. MR angiography was not possible in two patients. In another patient, the quality of MR angiography was not sufficient to assess the treated aneurysm. In 72 of the remaining 80 MR angiographic and DSA examinations, there was good correlation between the two modalities. In 54 cases, neither image type showed remnants or recurrence, but in 18, both showed residual aneurysm. In eight cases, the MR angiographic and DSA results differed. In one of these cases, MR angiography depicted residual aneurysm but DSA depicted an arterial loop. In seven cases, a small (<3-mm) remnant was not detected at MR angiography. CONCLUSION: Because very small aneurysm remnants or recurrences probably are not clinically important, MR angiography is an option for following up intracranial aneurysms treated with detachable coils and may partly replace DSA.     

Embolization of ruptured intracranial aneurysms with detachable coils: case series

Purpose  

We present a series of patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms who were treated with endovascular embolization by detachable coils.     

Follow-up of intracranial aneurysms treated with detachable coils: comparison of plain radiographs, 3D time-of-flight MRA and digital subtraction angiography

All patients with aneurysms treated with Guglielmi detachable coils (GDC) are undergo angiography to assess long-term stability of aneurysm exclusion or to show recurrence of the aneurysm sac, which may require further treatment. We prospectively compared the plain-film appearance of the coil-mass, 3D time-of-flight MR angiography (TOF MRA) and digital subtraction angiography (DSA) for the detection of aneurysm recanalisation during follow-up. We studied 60 patients with 74 intracranial aneurysms treated with Guglielmi detachable coils. We used the unsubtracted image of the angiograms performed at the completion of any embolisation procedure and at follow-up as the plain radiographs. Recanalisation was considered if loosening, compaction or reorientation of the coil mass was apparent. TOF MRA was performed to assess the presence and size of a neck remnant. DSA was regarded as the definitive investigation. Comparison of the techniques showed good agreement as regards aneurysm recanalisation. MRA was more accurate than plain radiography and could replace DSA for long term follow- up. The initial follow-up examination should, however, include both modalities. In cases of contraindications or limitations to MRA, the interval between follow-up angiographic examinations could be increased if there is no change in the plain-film coil-mass appearances.     

Endovascular treatment of intracranial aneurysms with matrix detachable coils: immediate posttreatment results from a prospective multicenter registry

BACKGROUND AND PURPOSE: Endovascular treatment of intracranial aneurysms by using detachable coils has become an accepted alternative to surgery. To reduce the rate of aneurysm recanalization after treatment, biologically active polyglycolic/polylactic acid-covered platinum coils have been proposed. A prospective and multicenter registry was conducted in France to evaluate the safety and short-term and long-term efficacy of Matrix detachable coils. This first analysis is focused on the safety and short-term efficacy. METHODS: Two hundred sixty-one patients having ruptured or unruptured aneurysms treated via endovascular approach were included in this registry. Patients with giant aneurysms or in poor clinical condition (Glasgow Coma Scale < 10) were excluded. Because of various protocol violations, clinical analysis was conducted in 236 patients having 244 aneurysms. Technical and clinical complications were systematically recorded. Angiographic analysis was performed by a core laboratory by using the Raymond Grading Scale on 224 patients having 232 aneurysms. RESULTS: Complete occlusion was achieved in 102 aneurysms (44.0%); neck remnant, in 58 aneurysms (25.0%); and aneurysm remnant, in 72 aneurysms (31.0%). Technical and clinical complications related to the procedure were encountered in 43 patients (18.2%). Postoperative modification of the clinical status was observed in 12 patients (5.1%). Two patients died (0.8%), 6 had a permanent deficit (2.5%), and 4 had a transient deficit (1.7%). Treatment-related mortality was 0.8% and permanent morbidity was 2.5%. CONCLUSION: Endovascular treatment of intracranial aneurysms by using Matrix detachable coils is feasible and demonstrated initial angiographic results and overall morbidity and mortality rates that are within the ranges found in the literature in the use of bare platinum coils.     

Endovascular treatment of intracranial aneurysms with matrix detachable coils: midterm anatomic follow-up from a prospective multicenter registry

BACKGROUND AND PURPOSE: Polyglycolic/polylactic acid–covered platinum coils have been proposed to reduce the rate of aneurysm recanalization after endovascular treatment. A prospective and multicenter registry was conducted in France to evaluate the safety and short-term and midterm efficacy of Matrix coils. This analysis focused on anatomic midterm results.MATERIALS AND METHODS: Two hundred thirty-six patients harboring 244 ruptured or unruptured aneurysms treated via endovascular approach by using Matrix coils were included in this registry. Treatment was totally or partially performed by using Matrix coils. Anatomic results were evaluated on postoperative and last-follow-up digital subtraction angiography (DSA) by using the Raymond scale. “Recanalization” was defined as worsening, and “progressive thrombosis” was defined as improvement on the Raymond scale.RESULTS: Anatomic midterm follow-up was obtained in 165 of 236 patients (70%) harboring 171 aneurysms (range, 6–27 months; mean, 14 ± 4 months). At midterm follow-up angiography, 79 aneurysms were completely occluded (46.2%), 43 had a neck remnant (25.1%), and 49 had an aneurysm remnant (28.7%). Of 171 aneurysms, recanalization was observed in 44 patients (25.7%), including major recanalization in 18 patients (10.5%). Recanalization was more frequent if the embolized volume of aneurysm was ≤25%. Progressive thrombosis was observed in 52 aneurysms (30%). No bleeding or rebleeding was observed during the period of follow-up.CONCLUSION: The efficacy of Matrix coils in preventing recanalization was not demonstrated in our series. In agreement with previous studies using bare platinum coils, volumic occlusion was an important feature for the prediction of aneurysm recanalization. A high percentage of progressive thrombosis in incompletely treated aneurysms was observed in our series, suggesting a biologic activity of Matrix coils.

Endovascular treatment by using bare platinum coils is currently used in patients worldwide as an alternative to surgery to occlude ruptured and unruptured cerebral aneurysms.¹ The most significant limitation of the technique is aneurysm recanalization that may occur in 15%–30%^2–5 and may potentially lead to aneurysm rebleeding. The modification of the surface of bare platinum coils was proposed in the late 1990s to accelerate the biologic response to coils and subsequently reduce the rate of recanalization.^6–7The first coated coil available for clinical use was covered with a bioactive copolymer consisting of polyglycolic/polylactic acid (PGLA).⁷ Several monocentric series have been recently published regarding the short- and midterm clinical and anatomic results of Matrix detachable coils (Boston Scientific, Natick, Mass) in the treatment of cerebral aneurysms.^8–12 A small number of patients were included in most series (25–112 patients), and midterm clinical and anatomic results were not always available.We recently published the immediate clinical and anatomic posttreatment results of a large prospective multicenter registry conducted in France in 2004.¹³ In this series, the overall morbidity and mortality rates of patients with intracranial aneurysms treated with Matrix detachable coils were within the ranges of previously published series using bare platinum coils. Similar results were reported by other teams.^8–12The potential influence of PGLA platinum coils on anatomic results in the time course after endovascular treatment of intracranial aneurysms remains debated. In a preliminary study, Kang et al⁸ found that the recanalization rate by the use of PGLA-coated coils was similar to that previously reported with the use of bare platinum coils. More recently, Niimi et al¹² found a higher recanalization rate with Matrix coils, whereas Murayama et al,¹¹ in the largest series published, to our knowledge, showed that anatomic results at midterm follow-up were better with Matrix coils compared with the Guglielmi detachable coil (GDC, Boston Scientific) system.The objective of the present study was to evaluate the midterm anatomic results in 165 patients harboring 171 intracranial aneurysms treated by Matrix coils and included in a prospective multicenter French registry.     

Time-of-flight magnetic resonance angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils

The purpose of this study was to evaluate time-of-flight magnetic resonance angiography (MRA) in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils (GDCs). From January 1998 to January 2002 27 MRA and intra-arterial digital subtraction angiography (IADSA) examinations were analyzed for residual aneurysms and arterial patency following GDC placement. A total number of 33 intracranial aneurysms was analyzed, including 18 located in the posterior circulation. The MRA analysis was based on source images in combination with maximum intensity projections. The IADSA was used as the reference standard. Two aneurysms were excluded from evaluation, because of susceptibility artefacts from other aneurysms, which were clipped. Sensitivity and positive predictive values of MRA in revealing residual aneurysms were, respectively, 89% and 80%. Specificity in ruling out remnant necks and residual flow around coils was, respectively, 91% and 97%, with a negative predictive value of, respectively, 95% and 100%. Specificity and negative predictive value of MRA for arterial occlusion were, respectively, 87% and 100% for the parent arteries and, respectively, 85% and 100% for the adjacent arteries. MRA is a reliable diagnostic tool in the follow-up of GDC treatment, and it may replace IADSA in excluding residual flow around coils and aneurysmal necks and in ruling out arterial occlusion.No grant support. This paper was presented in whole at the following meetings: ECR, Vienna, March 2003; CIRSE, Lucerne, October 2002     

Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils

BACKGROUND AND PURPOSE: Intravascular treatment of intracranial aneurysms is a relatively new therapeutic technique and long-term controlled angiographic trials are needed to assess persistence of aneurysm occlusion. Our purpose was to evaluate the effectiveness of 3D time-of-flight (3D-TOF) MR angiography as a noninvasive screening tool in the follow-up of cerebral aneurysms treated with Guglielmi detachable coils (GDCs). METHODS: Forty-nine patients with 50 intracranial aneurysms previously treated with GDCs were studied with both DSA and 3D-TOF MR angiography. In 14 cases, a second follow-up examination was performed, for a total of 64 aneurysms evaluated. In 25 aneurysms, both pre- and postcontrast MR angiographic studies were obtained. RESULTS: In seven of 64 aneurysms, the MR angiographic studies were considered to be unreliable owing to the presence of artifacts that obscured part of the parent artery and did not allow an accurate evaluation of the aneurysm neck. These seven aneurysms, however, all were shown to be completely occluded at digital subtraction angiography (DSA). In the remaining 57 aneurysms, DSA revealed complete occlusion in 39 and the presence of residual patency in 18, whereas MR angiography showed complete occlusion in 38 and residual patency in 19. Enhanced MR angiography proved to be useful in evaluating residual patency in large and giant aneurysms and in better depicting the distal branch arteries. CONCLUSION: Although artifacts related to the presence of coils are evident on a considerable number of imaging studies, our findings indicate that MR angiography is useful in the evaluation of residual patency of cerebral aneurysms treated with GDCs and may eventually prove valuable in the follow-up of those cases in which a good initial correlation with DSA was demonstrated.     

Follow-up of intracranial aneurysms selectively treated with coils: Prospective evaluation of contrast-enhanced MR angiography

BACKGROUND AND PURPOSE: The aim of this study was to determine the feasibility and usefulness of contrast-enhanced MR angiography (CE-MRA) for the follow-up of intracranial aneurysms treated with detachable coils, by comparing CE-MRA with digital subtraction angiography (DSA) and 3D time-of- flight (TOF) MRA. METHODS: Thirty-two patients with 42 treated aneurysms were included in the study; 6 had been treated for multiple aneurysms. All MRAs were performed with a 1.5T unit within 48 hours of DSA. We performed 2 types of acquisition: a 3D TOF sequence and CE-MRA. Twenty-eight patients were included 1 year after endovascular treatment, and 4 patients, after 3 years or more. DSA was the technique of reference for the detection of a residual neck or residual aneurysm. RESULTS: Compared with DSA, the sensitivity of MRA was good. For the detection of residual neck, there was no significant difference between the results of 3D TOF MRA (sensitivity, 75%-87.5%; specificity, 92.9%, according to both readers) and CE-MRA (sensitivity, 75%-82.1%; specificity, 85.7%-92.9%). For the detection of residual aneurysm, sensitivity and specificity of both techniques were the same, respectively 80%-100% and 97.3%-100%. Therefore, CE-MRA was not better than 3D TOF MRA for the detection of residual neck or residual aneurysm. For large treated aneurysms, there was no difference between decisions regarding further therapy after CE and 3D TOF MRA, even though CE-MRA with a short echotime and enhancement gave fewer artifacts and better visualization of recanalization than 3D TOF MRA. The interpretation of transverse source images and the detection of coil mesh packing seemed easier with 3D TOF imaging. CONCLUSION: This prospective study did not show that CE-MRA was significantly better than 3D TOF MRA for depicting aneurysm or neck remnants after selective endovascular treatment using coils. For aneurysms treated with coils, 3D TOF MRA seems a valid and useful technique for the follow-up of coiled aneurysms.     

颅内动脉瘤电解可脱性弹簧圈栓塞术后随访观察

目的　评价颅内动脉瘤电解可脱性弹簧圈 (GDC)栓塞治疗的中、远期疗效。方法　采用GDC栓塞 131例共 134枚颅内动脉瘤 ,其中前交通动脉瘤 39枚 ,后交通动脉瘤 4 5枚 ,颈内动脉虹吸段动脉瘤 19枚 ,大脑中动脉瘤 14枚 ,大脑前动脉瘤 3枚 ,后循环动脉瘤 9枚 ,其他部位 5枚。宽颈动脉瘤 (瘤颈宽度 >4mm或瘤体颈比率 <2 ) 39枚 ,狭颈动脉瘤 79枚 ,瘤颈显示不清者 16枚。栓塞术后 15个月内随访DSA ,以与栓塞后即时DSA比较其变化。结果　在 39枚宽颈动脉瘤和 79枚狭颈动脉瘤中 ,完全、近完全闭塞者分别为 30枚 (76 92 % )和 75枚 (94 94 % ) ,两者差异有非常显著性意义(χ2 =8 6 4 3,P <0 0 1)。栓塞后即时完全、近完全闭塞的 118枚动脉瘤中 ,术后不同时期随访DSA显示均无变化 ;栓塞后即时部分疏松填塞的 16枚动脉瘤中 ,随访DSA显示动脉瘤缩小者 3枚 ,无变化者4枚 ,再开放扩大者 9枚。结论　GDC致密、完全栓塞颅内动脉瘤的近、中期疗效肯定 ,但定期随访行DSA检查是必要的 ,尤其是部分疏松填塞者 ,对于复发的病例 ,可再行GDC栓塞     

Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women—2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved.     

Angiographic follow-up of vertebrobasilar artery aneurysms treated with detachable coils

Endovascular treatment of ruptured vertebrobasilar artery aneurysms with Gugliemi detachable coils (GDC) has become an alternative to surgery. Mid-term angiographic follow-up can now be reported. Of 111 vertebrobasilar aneurysms in 110 patients we treated with GDC since 1992, 53 underwent angiography within 1 year and 59 after more than 18 months. We did not achieve complete occlusion on initial treatment of 23 aneurysms (21%). Complications were observed in 19 patients (17%), leading to permanent clinical disability in eight. Enlargement of the neck or reopening was seen in 12 (23%) of 53 aneurysms followed by angiography within 12 months. Documented recanalisation was treated in four (8%). Angiography was performed after 18–78 months in 59 patients, of whom nine, including three with initially incomplete occlusions, were retreated with GDC. Within the entire second observation period, three (5%) of the 59 patients had a further haemorrhage and were retreated with GDC. Rebleeding proved to be the only factor influencing the clinical outcome of retreated patients.     

可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞大型颅内动脉瘤

目的 探讨可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞颅内大型动脉瘤的安全性和有效性。方法 可解脱弹簧圈结合游离纤毛铂金弹簧圈栓塞颅内大型动脉瘤4例,动脉瘤直径14～21mm,首先用可解脱弹簧圈在动脉瘤内成篮,然后用游离纤毛铂金弹簧圈进行篮内填塞,最后再用可解脱弹簧圈进行瘤体及瘤颈的致密栓塞。结果 3个动脉瘤获得完全致密栓塞,1个动脉瘤有瘤颈残留。临床随访3～12个月,无出血及脑缺血性事件发生。结论 可解脱弹簧圈结合游离纤毛铂金弹簧圈是一种可选的栓塞颅内大型动脉瘤安全、有效的方法。