Mid-long term follow-up of endovascularly treated intracranial aneurysms

Year 2019, Volume: 11 Issue: 2, 94 - 100, 01.06.2019

Doğukan Atabay İsmet Miraç Çakır , Şükrü Oğuz , Oğuzhan Özdemir Eser Bulut Hasan Dinç

https://doi.org/10.21601/ortadogutipdergisi.431000

Abstract

Aim: Surgical clipping is the gold standard treatment
method for the treatment of intracranial aneurysms, but endovascular therapy has
become an alternative to surgical treatment for the last 30 years. In aneurysms treated with the endovascular method, recurrence may
develop due to the mechanic failure of coil. The purpose of this study is; endovascularly-treated aneurysms follow
up as planed.

Material and Method: The study included 149 aneurysms of 130 patients
treated and controlled endovascularly between January 2004 and December 2013. 72
of the patients were women, and 58 were males. Patients were between 13 and 81 years
of age and the mean age was 50.9. Patients were followed for 6 to 84 months by magnetic
resonance angiography and digital subtraction angiography. Morphological results
were evaluated according to the Raymond classification. Raymond 1 (total occlusion),
Raymond 2 (filling of the aneurysm neck) and Raymond 3 (residual aneurysm).

Results: Raymond class 1 occlusion was obtained in 116
aneurysms treated with endovascular treatment (77.9%), Raymond class 2 in 16 aneurysms
(10.9%) and Raymond class 3 occlusion in 17 aneurysms (11.4%). The total recanalization
rate was 22.1%. Of 33 patients with Raymond class 2 and 3, 17 were diagnosed at
the 6th month. The remaining 14 patients were diagnosed at the 1st year controls
and 2 patients at the 2nd year controls. Of the 33 aneurysms with remnant-recurrence,
5 were giant aneurysms (> 25 mm), 14 were large aneurysms (10-25 mm), and 14
were small aneurysms (<10 mm).

Conclusion: It is important to assess the stability of
follow-up treatment after endovascular treatment and to detect early of recurrence.
Many studies have reported that at least two controls should be performed within
the first year after endovascular treatment. Long term follow-up is an appropriate
choice to perform with magnetic resonance angiography.

Keywords

İntracranial aneurysm, endovascular treatment, digital subtraction angiography

Endovasküler yolla tedavi edilmiş serebral anevrizmaların orta-uzun dönem takibi

Abstract

Giriş ve Amaç: İntrakraniyal anevrizmaların tedavisinde cerrahi
yolla klipleme altın standart tedavi metodu iken son 30 yıldır endovasküler tedavi
cerrahi tedaviye alternatif hale gelmiştir. Endovasküler yol ile tedavi edilen anevrizmalarda,
total oklüzyon sağlanmasına rağmen koillerin mekanik başarısızlığına bağlı nüks
gelişebilir. Bu çalışmanın amacı; endovasküler yol ile tedavi edilmiş anevrizmaların
takibi olarak planlanmıştır.

Gereç ve Yöntem: Çalışmaya Ocak 2004-Aralık 2013 tarihleri
arasında endovasküler yolla tedavi edilen ve kontrollerine uyan 130 hastaya ait
149 anevrizma dahil edildi. Hastaların 72’si kadın, 58’i erkektir. Hastaların yaşı
13 ile 81 yaş arasında olup ortalama yaş 50,9’dur. Hastalar 6-84 ay arasında manyetik
rezonans anjiyografi ve dijital substraksiyon anjiyografi ile takip edildi. Morfolojik
sonuçlar Raymond sınıflamasına göre değerlendirildi. Raymond 1 (total oklüzyon),
Raymond 2 (anevrizma boynunda doluş var) ve Raymond 3 (rezidü anevrizma) şeklindedir.

Bulgular: Endovasküler yolla tedavi edilmiş 116 anevrizmada
(%77,9) Raymond sınıf 1, 16 anevrizmada (%10,9) Raymond sınıf 2, 17 anevrizmada
(%11,4) Raymond sınıf 3 oklüzyon elde edilmiştir. Toplam rekanalizasyon oranı %22,1
bulunmuştur. Raymond sınıf 2 ve 3 olan 33 hastanın 17 tanesi 6.ay kontrollerinde
tespit edilmiştir. Kalan 14 hasta 1.yıl kontrollerinde 2 hasta ise 2.yıl kontrollerinde
tespit edilmiştir. Remnant-nüks tespit edilen 33 anevrizmanın 5 tanesi dev anevrizma
(>25mm), 14 tanesi büyük anevrizma (10-25 mm), 14 tanesi ise küçük anevrizmlarda
(<10mm) izlenmiştir.

Sonuç: Endovasküler tedavi sonrası takipler tedavinin
stabilitesini değerlendirmek ve oluşabilecek nüksü erken dönemde saptanmasında önemlidir.
Birçok çalışmada endovasküler tedavi sonrasında ilk yıl içerisinde en az iki kontrol
yapılması gerektiği bildirilmektedir. Uzun dönem takiplerin manyetik rezonans anjiyografi
ile yapılması uygun bir seçenektir.

Keywords

İntrakranial anevrizma, endovasküler tedavi, dijital subtraksiyon anjiyografi

References

• Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via an endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 1991; 75: 8–14.
• Molyneux A, Kerr R, Stratton I, ve ark. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360: 1267-74.
• Cognard C, Weill A, Castaings L, ve ark. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 1998; 206: 499–510.
• Cognard C, Weill A, Spelle L, ve ark. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 1999; 62: 348–56.
• Raymond J, Guilbert F, Weill A, ve ark. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34: 1398-403.
• Molyneux AJ, Kerr RS, Yu LM, ve ark. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clippingversus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366: 809-17.
• Leclerc X, Navez JF, Gauvrit JY, ve ark. Aneurysms of the anterior communicatingartery treated with Guglielmi detachable coils: follow-up with contrastenhanced MR angiography. AJNR Am J Neuroradiol 2002; 23: 1121–27.
• Anzalone N, Scomazzoni F, Strada L, Patay Z, Scotti G. Intracranial vascular malformations. Eur Radiol 1998; 8: 685-90.
• Piotin M, Mandai S, Murphy KJ. Dense packing of cerebral aneurysms: An invitro study with platinum coils. AJNR Am J Neuroradiol 2000; 21: 757-60.
• Murayama Y, Nien YL, Duckwiler G, ve ark. Guglielmi detachable coil embolization ofcerebral aneurysms: 11 years’ experience. J Neurosurg 2003; 98: 959–66.
• Onuma T, Suzuki S: Surgical treatment of giant intracranial aneurysms. J. Neurosurg 1979; 51: 33-6.
• Leclerc X, Navez J, Gauvrit J, ve ark. Aneurysms of the anterior communicating artery treated with Guglielmi detachable coils: follow-up with contrast-enhanced MR angiography. AJNR Am J Neuroradiol 2002; 23: 1121–27.
• Gauvrit J, Leclerc X, Pernodet M, ve ark. Intracranial aneurysms treated with Guglielmi detachable coils: usefulness of 6-month imaging follow-up with contrast-enhanced MR angiography. Amc J Neuroradiol 2005; 26: 515-21.
• Gauvrit J, Leclerc X, Caron S, ve ark. Intracranial aneurysms treated with Guglielmi detachable coils: imaging follow-up with contrast-enhanced MR angiography. Stroke 2006; 37: 1033–7.
• Pierot L, Delcourt C, Bouquigny F, ve ark. Follow-up of intracranial aneurysms selectively treated with coils: prospective evaluation of contrast-enhanced MR angiography. AJNR Am J Neuroradiol 2006; 27: 744–9.
• Agid R, Willinsky RA, Lee SK, ve ark. Characterization of aneurysm remnants after endovascular treatment: contrast-enhanced MR angiography versus catheter digital subtraction angiography. AJNR Am J Neuroradiol 2008; 29: 1570–4.