| [Background] Intracranial aneurysms are tumor-like protrusions on the intracranial arterial wall,it is the first cause of spontaneous subarachnoid hemorrhage. In cerebral vascular accident, intracranial is in third place after hypertensive cerebral hemorrhage and cerebral thrombosis, which has higher rates of death and disability. The main onset form of intracranial is subarachnoid hemorrhage, without any signs before onsetUsually patients with tired, mood excited, blood pressure increased, const-ipation and so on have onset due to aneurysms ruptured to bleed,led to a series of cli-nical symptoms and signs.The main clinical performance of the disease are burst of dramatic headache, and dramatic of vomiting, sweat,sometimes temperature can inc-reased, k levy positive and neck ankylosing. Some patients can have mild impairment of consciousness, and even coma. The causes of intracranial aneurysm formation are not clear, most doctors are link to think some people with intracranial aneurysms may be congenital defects on intracranial arterial wall, and later in cerebral arteriosclerosis, hypertension, vascular inflammation and blood flow under impact and other reasons, partial wall gradually outward, forming an aneurysm.Currently,the main treatment of intracranial aneurysm has 2 species:one is traditional of aneurysm clipping or aneur-ysm wrapping, this treatment exists a long time,has exact effect, with lower recur- rence rate, but its wound is big and it has a higher relative complications and need stay more time in hospital.Another way is to treat aneurysms by vascular,with coil to fill in aneurysms. Compared to aneurysm clip, aneurysms coiled has small wound, less complications and recover fast, which has became a important method to treat cranial aneurysm in many hospitals.Endovascular embolization is mainly a natural passage through the body’s blood vessels,fill in the aneurysm with coil, separating aneurysm from intracranial blood circulation. Because of its advantage such as little wound, less complications and quick recovery, it has now become the main treatment in many hospitals. Although compared with aneurysm clipping, endovascular treatm-ent of intracranial aneurysms has many advantages, but incomplete embolization and various causes of recanalization are still one of the biggest problems in endovascular treatment of long-term curative effect, especially large and giant aneurysms have a hi-gher recurrence rate, the recurrence of the aneurysm causing ruptured is often happe-ned. Therefore, interventional treatment of intracranial aneurysms after coiled must accept long-term, multiple imaging follow-up. Once found recurrence and risking in aneurysm ruptured again, this patient should be timely retreated. The way to follow-u p aneurysms after coiled has three main methods:Digital Subtraction Angiography (DSA),Magnetic Resonance Angiography (MRA) and CT Angiography (CTA):DSA especially 3D-DSA is considered as"gold standard"of the diagnosis and follow-up of intracranial aneurysm. As an invasive check, DSA can temporarily causes reversible neurological defect, permanent neurologic complications and require hospitalization and higher costs.:MRA is he most widely used method in the interventional therapy and followed up of intracranial aneurysm at home and abroad. MRA has the advant-ages of non-invasive, non-ionizing radiation ans is widely used in aneurysm emboliz-ation as evaluation of follow-up checks with high accuracy. However, for some have placed pacemaker, and not out of dentures, and in not security parts indwelling metal iron and the heavy syndrome guardianship of patients, MRA check is not security; CTA is often useful to detect intracranial aneurysms before operation, but due to its exists obviously metal pseudo shadow, and hardly to be used to follow up aneurysms coiled. Clinically, there is an urgent need for a simple, non-invasive, suitable method for all aneurysms after interventional therapy in patients.[Object] our study aimed at supplying a new,safe,convenient follow-up way for aneurysms coiled.Material is used in interventional therapy of intracranial aneurysm with GDC.according to the principle of X-ray not through GDC, we compared the coil mass difference at the same position after the intervention with follow-up in GDC to judge whether the aneurysm recurred. The purpose of the article was to access the value of X-ray plain film to be used as follow up examination for intracranial aneurysms coiled.[Method 11.Patients and aneurysms:From August 2013 to June 2015,86consecu-tive patients with intracranial aneurysms received operating position angiography to follow up the aneurysms of coil embolization were collected. All these patients were treated by endovascular coiling and followed up by digital subtraction angiography in our center. There were102 aneurysms in 86 patients,5 patients had two aneurysms and 7 patients had been followed twice, they all had been counted as two aneurysms respectively.3 patients had three aneurysms and they all had been counted as three aneurysms respectively. The mean age(32 to 69, years) was 51 year old,38 patients were male,48 patients were female. The mean time of following up(0.5 to 23, mont hs) was 6 months.7 aneurysms were dissecting aneurysms. Stent was used in 80 ane-urysms.14 carotid-ophthalmic carotid artery aneurysms,14 anterior communication artery aneurysms,39 carotid-posterior communication arte ry aneurysms,18 middle cerebral artery aneurysms,7 basilar artery aneurysms,2 posterior inferior cerebellar artery aneurysms,4 vertebral artery aneurysms,2 posterior cerebral artery aneurysms, 1 superior cerebellar artery aneurysm and 1 vertebral-posterior cerebral artery aneur-ysm.84 small aneurysms (<10mm),18 large aneurysms (10mm to 25mm).Mean dia-meter(2.7 to 23.7 mm) was 6.6mm.2.Endovascular treatment and follow up:All proc-edures were performed on a Siemens biplane C-arm angiography system.3-dimen- sional images of the vessel can be reconstructed on a XWP workstation. After detecti-ng aneurysm, our neurosurgeons would select a suitable operating position that could display mutual relationship of aneurysm body, neck and parent artery.Next,all selecte-d patients were treated by endovascular coiling with DGC at operating position until aneurysms weren’t perfused by contrast agent. The last operating angiographys were what we need and we got the corresponding X-ray plain film images that could view-ed coil mass morphology distinctly from the station. After treatment,we performed a "0°/CRAN 30°" and "LAO 90°/0°" position angiography conventionally. During the follow up of these aneurysms after embolization,we performed angiography at the op-erating and "0°/CRAN 30°" and "LAO 90/0°" positions, and thus we obtained the corresponding X-ray plain film images.As X-ray plain film just showed a profile of coil mass,we need several X-ray plain films at different positions to view the morph-ology of coil mass. Not all patients followed up by DSA performed at operation pos-ition,any patient who needed to preserve a operation position angiogram didn’t inten-tionally make a choice before follow up.3.Compare methods:First step:two neurosu-rgeons compared the corresponding coil mass morphology of each aneurysm on X-ra-y plain film image acquired post-treatment with that from follow-up independently. If any obvious deviation was detected, we signed "change",if not, we signed "stable". After that, neurosurgeons decided whether the aneurysm recurred according to the previous results. During signing, we encounter a special situation:the morphology of some coil mass changed at some position and didn’t change at other position, it was hard for us to decide. For this, we come up with a solution:neurosurgeons referred post-operation images including angiography and 3-dimens-ional reconstruction, coil mass morphology on X-ray plain film images at those pos- itions where could display mutual relationship of aneurysm body, neck and parent artery with least overlap were regarded as major reference, others were secondary.For every coil mass,we should take neck variation as major reference. Because a aneurysm was perfused by contrast agent again, neck recurrence was necessary. Cases leading to a disagreement between the two observers were reviewed by both readers to reach a consensus. Those aneu-rysms were followed up more than once, and we only compared this result with the last follow-up.Second step:Another two neurosurgeons determined whether aneury-sms recurred at DSA which included 3-dimensionaI reconstruction. A recurrence was defined as any increase in the size of the remnant. Recurrences were subjectively div-ided into major(ideally necessitating re-treatment) and minor.Third step:we compare-d the first step’s result with the second step’s and took the second step result as a refe-rence.4.Statistic analysis:As statistical analysis, we used Kappa statistic, (poor agree-ment,K=0; slight agreement,K=0.01-0.20;fair agreem-ent,K=0.21-0.40;moderate agr-eement,K=0.41-0.60;good agreement,K=0.61-0.80;excellent agreement,K=0.81-1.00), P values less than 0.01 indicated a significant difference.[Result] For 90 in 102 aneurysms, the result of fluoroscopy were in line with DSA (Figurel-Figure4),the accurate rate of X-ray plain film for aneurysms follow up after coiling was 88.24%. X-ray plain film to follow-up aneurysms had a sensitivity and a specificity of 92.86% and 85.00%.There was hardly difference in coil morphology in 3 cases, which were not defin-ed as recurred. However,DSA indicated the aneurysms recurred.9 cases were defined as recurred by comparing the coil morphology using fluor-oscopy, but these changes were not reflected in DSA. Among them, the coil morphol-ogy shrunk and changed overall in 3 cases. There was a little difference in 2 cases,we thought they recurred, whereas DSA showed remnant after treatment decreased at fo-llow-up.1 case was found as recurred in the first follow-up and wasn’t re-treated with coil, there were no significant difference in the second follow-up. For this case,we thought the aneurysm existed, but the twice follow-up DSA didn’t find the aneurysm. There were minor changes on coil morphology image in 3 cases and we defined them recurred, but no-recurrence was decided in DSA. |
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