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目的报道用弹簧圈再次栓塞或覆膜支架治疗颅内复发动脉瘤的经验。方法291例患者共305枚颅内动脉瘤行可脱卸弹簧圈治疗。随访期间,142例颅内动脉瘤中有41例(28.9%)动脉瘤复发。6个月内有脑血管造影随访的31例共31枚复发动脉瘤纳入本研究,其中20例行可脱卸弹簧圈再栓塞(A组),11例行覆膜支架置入术(B组)。将动脉瘤血管造影结果分为完全闭塞、不完全闭塞;临床评估分级为完全康复,改善,无变化,加重或进展。收集并分析技术成功率,即刻和末次血管造影结果等资料。结果所有复发动脉瘤弹簧圈栓塞和支架置入技术均获得成功。即刻脑血管造影示A组11例(55%)动脉瘤完全闭塞,B组8例(72.7%)完全闭塞;末次脑血管造影示A组10例(50%)动脉瘤完全闭塞,B组11例(100%)完全闭塞,两组间差异有统计学意义(P=0.005)。结论弹簧圈栓塞后动脉瘤复发,可以行弹簧圈再次栓塞术或覆膜支架置入术治疗和闭塞瘤腔。覆膜支架可能比弹簧圈栓塞能更有效地完全闭塞复发动脉瘤。
Objective To report the experience of re-embolization or stent-graft for recurrent intracranial aneurysms with coils. Methods A total of 305 intracranial aneurysms in 291 patients were treated with a detachable coil. During follow-up, 41 (28.9%) of 142 aneurysms recurred. A total of 31 recurrent aneurysms with cerebral angiography follow-up within 6 months were included in this study. Among them, 20 patients underwent revaccable coil re-embolization (group A) and 11 patients underwent stent graft (group B) . Aneurysm angiography results are classified as completely occluded, not completely occluded; clinical assessment grading complete recovery, improvement, no change, increase or progress. Collect and analyze data on technical success rates, immediate and final angiographic findings. Results All relapsed aneurysm coil embolization and stent placement techniques were successful. Immediate cerebrovascular angiography showed complete occlusion of aneurysm in group A (n = 11) (55%) and complete occlusion in group B (n = 8) (72.7%). Cerebral angiography showed complete occlusion in 10 patients Cases (100%) completely occluded, the difference between the two groups was statistically significant (P = 0.005). Conclusion The aneurysm recurrence after coil embolization can be re-embolization or stent-graft surgery to treat and occlude the tumor cavity. A covered stent may completely occlude a recurrent aneurysm more effectively than a coil embolization.