Doğukan ATABAY, İsmet Miraç ÇAKIR, Şükrü OĞUZ, Oğuzhan ÖZDEMİR, Eser BULUT, Hasan DİNÇ

Endovasküler yolla tedavi edilmiş serebral anevrizmaların orta-uzun dönem takibi

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.

Anahtar Kelimeler:

İntrakranial anevrizma, endovasküler tedavi, dijital subtraksiyon anjiyografi

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

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,

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