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Clinical Study of Short-and Medium-term Recurrence After Embolization of Intracranial Aneurysms with Detachable Coils

Author: WenYuDong
Tutor: WeiJianJun；FuXianMing；NiuChaoShi；WeiXiangPin；ZhangYang
School: Anhui Medical University,
Course: Surgery
Keywords: ntracranial aneurysm Embolization therapeutic Recurrence Coil
CLC: R739.41
Type: Master's thesis
Year: 2011
Downloads: 54
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Abstract

Objective To observe the short-and medium-term recurrence after embolization of intracranial aneurysms with detachable coils and to analyze the factors affecting the recurrence of aneurysm.Methods We followed up a total of 320 patients (368 aneurysms) with intracranial aneurysms treated with detachable coils in Anhui Provincial Hospital Affiliated to Anhui Medical University from June 2005 to June 2009. 81 patients (total 89 aneurysms) were followed up≤6 months, in which 63 patients (total 65 aneurysms) were followed up for 6 to 12 months, and 48 of them (48 aneurysms) were followed up for >12 months. The recurrence of the aneurysm, the extent of embolization, the size of aneurysm, and the impact of aneurysm neck on the recurrence of aneurysm were observed.Results①Among the 89 aneurysms were followed up for≤6 months ,13 were recurred (14.6%); among the 65 aneurysms were for 6 to 12 months,7 were recurred (10.8%) ;and among 48 aneurysms followed up >12 months, 4 recurred (8.3%).②During the follow up period, the patients did not have rebleeding and other newly developed neurological symptoms. Four patients left mild hemiplegia,and 1 left severe hemiplegia.③Three follow-up results showed that the recurrence rate in patiens with complete embolization was lower than those with sub-total and partial embolization. The difference was statistically significan (all P<0.05). The recurrence rate of giant aneurysm was higher than that of small and medium-sized aneurysms, when the follow-up time was≤12 months, the difference was not statistically significant (P>0.05). When the follow-up time was > 12 months, the difference was statistically significant (P<0.01). There is no significant difference for the recurrence rate between wide-necked aneurysms and narrow-necked aneurysms in the follow-up period≤6 months. As the follow-up period prolonged, the recurrence rate of wide-necked aneurysms was significantly higher than that of narrow-necked aneurysms (P<0.05).Conclusion Traditional treatment is surgical aneurysm craniotomy clipping surgery, although detachable latex balloon through the endovascular treatment of traumatic carotid-cavernous fistula cases was reported successfully, the interventional treatment of intracranial aneurysm has been utilized as it has better curative effect and rapid recovery characteristics. In addition, with the continuous development of embolic material, endovascular treatment become new luminescent spot in the treatment of intracranial aneurysms,and it was considered safe and effective as clpping. However, more intracranial aneurysms embolized, more cases recurred after the procedures,which made people becom more cautious to Choose treatments.Although the recurrence rate was high after the treatment, it is still the effective treatment of intracranial aneurysms because of the low mortality and morbidity. Dense packing of the aneurysmal sac may reduce the recurrence rate of aneurysms. Close follow-up with imaging is necessary after aneurysm embolization. Aneurysms recurred should be retreated, and the interventional treatment of intracranial aneurysm recurred is Safer than other method. Thus, radiologic follow-up is essential for optimal management in order to identify aneurysm recurrence and prevent rebleeding. Taking into account late recurrences, radiologic follow-up should be performed over a 5-year period by means of CTA or DSA angiography and in comparison with previous aneurismal occlusion status。

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