Résumé
Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) in patients with ruptured intracranial aneurysms in the acute phase. Methods Totally 91 patients with 91 intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014 and December 2016. Among them, 37 patients were treated with BAC and 54 patients with SAC respectively. Of the two groups, the position distribution and shape of aneurysms, and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test. Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs. 4.35±2.10 mm, P=0.01). The aneurysm body/neck ratio (B/N) was lower in the BAC-treated group than in the SAC-treated group (1.64 ± 0.46 vs. 1.35±0.66, P=0.025). The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group (18.9％ vs. 0.9％, P=0.005). There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However, 2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score, mRS, 0-2) were achieved in the BAC-treated group compared to the SAC-treated group (94.6％ vs. 88.9％, P=0.028) at the follow-up visit. Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication. BAC can achieve a better prognosis,but it is more prone to relapse. The SAC method was more appropriate for wider neck aneurysms. It was also an option to coiling the aneurysm in BAC in acute phase firstly, followed by additional treatment in SAC during the follow-up period.
Résumé
OBJECTIVE: The purpose of this study was to evaluate the occurrence rate of diffusion positive lesions (DPLs), and to assess the peri-procedural risk factors for the occurrence of DPLs in patients who underwent coil embolization of cerebral aneurysms. MATERIALS AND METHODS: A total of 304 saccular aneurysms were embolized during a seven-year period from Jan 2007 to Dec 2013. Of these, postoperative diffusion-weighted images were obtained in 186 procedures. There were 100 ruptured aneurysm and 86 unruptured aneurysms. The coiling procedures were as follows: simple coiling in 96, balloon assisted coiling (BAC) in 39, and stent assisted coiling (SAC) in 51 aneurysms. Clinical, angiographic and procedural factors were analyzed in relation to the occurrence of DPLs. RESULTS: Overall, DPLs were observed in 50.5%. In unruptured aneurysms, DPLs occurred in 23.5% of BAC, 41.9% of SAC and 57.7% of simple coiling (p = 0.08). Among ruptured aneurysms, DPLs occurred in 63.6% of BAC, 62.5% of SAC and 54.3% of simple coiling (p = 0.71). DPLs had a tendency to increase in ruptured aneurysms compared with unruptured aneurysms (57% vs. 43%, p = 0.077). Logistic regression analysis revealed that age > 55 years was the only independent risk factor for the occurrence of DPLs. CONCLUSION: DPLs occured more frequently in ruptured aneurysm and at an older age. Although most DPLs are asymptomatic, careful manipulation of cerebral or extracerebral arteries using various endovascular devices is important to reducing the occurrence of DPLs. BAC appeared to reduce occurrence of TE events in patient with unruptured aneurysm.