| Objective: Retrospectively collecting the clinical data of endovascular embolizedintracranial aneurysms cases.To summarize our date and to analyze the outcomes ofendovascular treatment for cerebral aneurysms. To investigate the efficacy,the safety,theincidence of procedural complications,the rate of angiographic recurrence and theprognostic factors of the intravascular interventional embolization on intracranialaneurysms, summarize the clinical experience and guide practice.Methods: a retrospective study of all patients admitted to Yi Ji Shan Hospital affiliatedto WanNan Medical College with intracranial aneurysms treated by endovasculartechniques from Sep1,2011to Sep31,2012.ALL of patient’s documents will beanalyzed,including location,size and shape of aneurysms,the gender and the age ofpatients,Preoperative Hunt-Hess grade,CT Fisher grade, coiling strategy,proceduralrelated complication,the extent of aneurysm occlusion, Modified Rankin Score(mRS),follow-up clinical and angiographic results.Chi-square test,Fisher exact test andWileoxon rank sum test were used by SPSS16.0statisties software to analysis theclinical data.Results:115patients harboring128intracranial aneurysms were found.Male40cases,Femal75cases,male/femal radio equal to1:1.875,the average age of male andfemale is55.26years old.118aneurysms were located in the anterior circulation and10in the posterior circulation.64were small aneurysms,62were midsize aneurysms,1waslarge aneurysm,1was giant aneurysm;70were saccular aneurysms,55were irregularaneurysms,3were dissecting and fusiform aneurysms;93were wide-necked aneurysms,35were narrow-necked aneurysms.Preoperative Hunt-Hess grade0-Ⅲ in102cases, Hunt-Hess gradeⅣ-Ⅴin13cases.CT Fisher grade1in13cases,grade2in85cases, grade3in11cases, grade4in6cases.121intracranial aneurysms were treated.65cases were stent-assisted coilembolization and56were coil embolization.Acute angiographic results demonstrateddense occlusion in83cases,neck residual in31cases,subtotal occlusion in7cases.Compared with wide-necked aneurysms and narrow-necked aneurysms in acuteangiographic results which it had no statistical significance(p>0.05). Perioperativecomplications occurred in14patients(12.1%),thromboembolic complications in6cases,severe cerebral vasospasm in2cases,acute hydrocephalus in2cases, proceduralruptures in4cases.leading to death in1patient(0.8%)and to disability in5patients(4.3%).Embolic approach and the size of the aneurysmal neck were not the riskfactor for the thromboembolic complications(p>0.05).At discharge favourable prognosis(MRS grade0-2) in104cases,poorprognosis(MRS grade3-6) in11cases, leading to death in3patient(2.6%) and todisability in8patients(6.9%).To compared preoperative Hunt-Hess grade0-Ⅲ withHunt-Hess gradeⅣ-Ⅴ, Two groups of MRS at discharge are statistically significantdifferences(p<0.01).To compared CT Fisher grade at admission with MRS atdischarge,it had no statistical significance (p>0.05).Follow-up angiogram(mean,6.1months) were obtained in74aneurysms.51aneurysms demonstrated stable,8aneurysmsdemonstrated progressive thrombosis,15aneurysms demonstrated recanalization,8aneurysms were treated again.All aneurysms demonstrated dense occlusion and had noprocedural complications.Aneurysms with subtotal occlusion were subjected torecanalization (p<0.01).No statistical difference was demonstrated betweenstent-assisted coil embolization and coil embolization when there were compared for therate of recanalization(p>0.05). The rate of recanalization of wide-necked aneurysms washigher than narrow-necked aneurysms(p<0.05).Stent-assisted coil embolization could significantly reduce the rate of recanalization than coil embolization for the therapy ofwide-necked aneurysms(p<0.01).98Patients had a mean clinical follow-up time of7.3months(range,3-15mo).MRS,0-2in90,MRS,3-6in8, leading to death in2patient(2.1%) and to disability in6patients(6.1%). Preoperative Hunt-Hess grade0-Ⅲin87cases, favourable prognosis in84cases, Preoperative Hunt-Hess grade Ⅳ-Ⅴ in11cases, favourable prognosis in6cases, Two groups of MRS demonstrated a statisticallysignificant (p<0.01).Conclusion: These data on firm the safety and efficacy of endovascular embomlizationfor patients with intracranial aneurysm;The size of the aneurysm has no influence on theinitial extent of occlusion of the aneurysm;Stent-assisted coil embolization can reducethe neck residual rate on the initial extent of occlusion of the aneurysm; Embolicapproach and the size of the aneurysmal neck were not the risk factor for thethromboembolic complications.Preoperative Hunt-Hess grade0-Ⅲ has the better prognosis than Hunt-Hess gradeⅣ-Ⅴ;CT Fisher grade on the endovascular treatment of aneurysms had no effect onprognosis.;Aneurysms with subtotal occlusion were subjected to recanalization; Nostatistical difference was demonstrated between stent-assisted coil embolization and coilembolization when there were compared for the rate of recanalization; The rate ofrecanalization of wide-necked aneurysms was higher than narrow-necked aneurysms;Stent-assisted coil embolization could significantly reduce the rate of recanalizationthan coil embolization for the therapy of wide-necked aneurysms;Follow-upangiography is mandatory after embolization of cerebral aneurysms. Re-treatment ofaneurysm recanalization due to a higher rate of recanalization is necessary and safe. |
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