前交通动脉瘤破裂线圈栓塞术后早期复发的评价。

Journal of neuroendovascular therapy Pub Date : 2025-01-01 Epub Date: 2025-04-18 DOI:10.5797/jnet.oa.2024-0086
Shin Yamashita, Tomoko Eto, Shinji Takahashi, Yuta Hamamoto, Terukazu Kuramoto, Masaru Hirohata, Motohiro Morioka
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引用次数: 0

摘要

目的:回顾性分析前交通动脉(AcomA)动脉瘤破裂行线圈栓塞术患者早期复发的危险因素。方法:纳入2012年1月至2021年6月期间44例AcomA动脉瘤破裂患者。回顾性回顾患者背景、解剖特征、术中抗凝及治疗前后的影像学表现。对早期复发(ER)组和非早期复发(NER)组所调查的每个项目分别进行单因素分析。此外,我们还研究了术后立即至2周后栓塞状态(Raymond-Roy分类[RRC])变化与疾病严重程度的关系。结果:再治疗8例(18.2%)。2例在慢性期发现并治疗,无再破裂。在ER组,6例(13.6%)患者在初始栓塞2周后数字减影血管造影显示RRC 3级充盈,无线圈压实证据,并再次治疗。平均术中活化凝血时间(ACT;P = 0.0226;NER中位数189.5 s, ER中位数149 s),对侧A1直径(p = 0.0264;NER中位数0.85 mm, ER中位数0.26 mm),体积栓塞率(VER;p = 0.02, ER组NER中位数35.57%,ER中位数20.86%)显著低于ER组。Hunt和Hess分级越严重,2周后栓塞情况(RRC)越差(p = 0.0339)。结论:本研究中,术中低ACT、低VER、对侧A1发育不全、病情严重程度等因素可能与AcomA动脉瘤破裂急性线圈栓塞术后早期复发有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of Early Recurrence after Coil Embolization for Ruptured Anterior Communicating Artery Aneurysms.

Objective: We retrospectively examined the risk factors for early recurrence in patients with ruptured anterior communicating artery (AcomA) aneurysms who underwent coil embolization.

Methods: Forty-four patients with ruptured AcomA aneurysms who underwent coil embolization between January 2012 and June 2021 were included. Patient backgrounds, anatomical features, intraoperative anticoagulation, and radiological findings before and after treatment were reviewed retrospectively. Univariate analysis was performed separately for each item investigated in the early recurrence (ER) and non-early recurrence (NER) groups. Additionally, the relationship between changes in embolic status (Raymond-Roy classification [RRC]) from immediately after surgery to 2 weeks later and severity of disease was investigated.

Results: Re-treatment was performed in a total of 8 (18.2%) cases. Two cases were detected and treated in the chronic phase with no re-rupture. In the ER group, 6 (13.6%) cases had RRC class 3 filling without evidence of coil compaction on digital subtraction angiography performed 2 weeks after the initial embolization, and were re-treated. The mean intraoperative activated clotting time (ACT; p = 0.0226; NER median 189.5 s, ER median 149 s), contralateral A1 diameter (p = 0.0264; NER median 0.85 mm, ER median 0.26 mm), and volume embolization rate (VER; p = 0.02, NER median 35.57%, ER median 20.86%) were significantly lower in the ER group. The more severe the Hunt and Hess grade, the worse the embolic condition (RRC) tended to be after 2 weeks (p = 0.0339).

Conclusion: In this study, factors such as low intraoperative ACT, low VER, contralateral A1 hypoplasia, and condition severity may be associated with early recurrence after acute coil embolization for ruptured AcomA aneurysms.

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