Necdet POYRAZ, Mehmet Fatih ERDİ, Süleyman BAKDIK, Bülent KAYA, Osman KOÇ

Rüptüre Olmamış İntrakranyal Anevrizmalarda Endovasküler Tedavi Yaklaşımları: Tek Merkezli Çalışma

Amaç: İntrakranyal rüptüre olmamış anevrizmalarda tam tedavi endikasyonları ve optimal tedavi stratejileri tartışmalıdır.Materyal-Metod: Bu çalışmada, tek bir merkezde farklı endovasküler tekniklerle tedavi edilen rüptüre olmamış anevrizma hastalarındaki sonuçlarımızı sunuyoruz. Nisan 2008 - Ekim 2014 tarihleri arasında, 100 ardışık hastada 106 adet rüptüre olmamış anevrizma, merkezimizde farklı endovasküler teknikler ile tedavi edildi. Çalışmada ortalama yaşı 53.2 yıl olup 15-76 yıl arasında dağılım gösteren 35 erkek 65 kadın hasta vardı. Anevrizmaların yeri, tipi, kompleksitesi ve büyüklüğüne göre endovasküler primer koilleme, balon veya stent yardımlı koilleme, intrasakküler akım yönlendiriciler veya parent arter oklüzyonu yapıldı.Bulgular: 6 aylık izlemde 101 anevrizmada (% 100) tam oklüzyon ve 5 anevrizmada (% 90 -% 100) ise tama yakın oklüzyon sağlandı. Dört hastanın 2'sinde tromboemboli ve 2 hastada ise işlem sırasında anevrizma perforasyonu gibi prosedürle ilgili komplikasyonlar oldu. Takip görüntüleme 61 hastada anjiografi ile, 16 hastada BT anjiyografi ve 23 hastada MR anjiyografi ile yapıldı. Ortalama izlem zamanı 10.05 ay (6-50 ay) idi.Sonuç: Rüptüre olmamış intrakranyal anevrizmaların endovasküler tedavisi, seçilmiş hastalarda risk-fayda analizine göre güvenli bir yöntem gibi gözükmektedir.

Anahtar Kelimeler:

Rüptüre olmamış intrakranyal anevrizmalar, Endovasküler Teknikler, Embolizasyon

Endovascular Management of Unruptured Intracranial Aneurysms: Single-Center Report

Objective: The exact treatment indications and optimal management strategies of patients with intracranial unruptured aneurysms remain controversial. Material-Method: In this study we present our results and clinical outcomes in a single center of patients with unruptured aneurysms treated with different endovascular techniques. Between April 2008 and October 2014, 106 unruptured aneurysms in 100 consecutive patients were treated with different endovascular techniques in our center. There were 35 male and 65 female patients with a median 53.2 years (range, 15-76 years). Endovascular primary coiling, coiling with balloon remodeling, stent assisted coiling, flow-diversion, intrasaccular flow-diversion or parent artery occlusion were performed according to location, type, complexity and size of the related unruptured aneurysms. Results: At 6 months follow-up, complete occlusion was achieved in 101 aneurysms (100%) and near-complete occlusion in 5 aneurysms (90%-100%). Four patients had procedure-related complications including thromboembolism in 2 patients and aneurysm perforation during the procedure in 2 patients. Follow-up imaging was performed with angiography in 61 patients, with CT angiography in 16 and with MR angiography in 23. Our median surveillance time was 10.05 months (6-50 months). Conclusion: Endovascular treatment of unruptured intracranial aneurysms seems to be a safe method in selected patients according to risk-benefit analysis.

Keywords:

Unruptured intracranial aneurysms, Endovascular techniques, Embolization,

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Referans1 Mangiafico S, Guarnieri G, Consoli A, Ambrosanio G, Muto M. Endovascular strategy for unruptured cerebral aneurysms. Eur J Radiol 2013;82(10):1638–45.
Referans2 Lin LM, Colby GP, Kim JE, Huang J, Tamargo RJ, Coon AL. Immediate and follow-up results for 44 consecutive cases of small (<10 mm) internal carotid artery aneurysms treated with the pipeline embolization device. Surg Neurol Int 2013;4:114.
Referans3 Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32(9):1998-2004.
Referans4 Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, et al. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms. Stroke 2015;46(8):2368–400.
Referans5 Yue W. Endovascular treatment of unruptured intracranial aneurysms. Interv Neuroradiol 2011;17(4): 420–4.
Referans6 Juvela S, Poussa K, Lehto H, Porras M. Natural history of unruptured intracranial aneurysms. Stroke 2013;44(9):2414-21.
Referans7 Tsukahara T, Murakami N, Sakurai Y, Yonekura M, Takahashi T, Inoue T, et al. Treatment of unruptured cerebral aneurysms; a multi-center study at Japanese national hospitals. Acta Neurochir Suppl 2005;94:77–85.
Referans8 Nasr DM, Brown RD. Management of unruptured intracranial aneurysms. Curr Cardiol Rep 2016;18(9):86.
Referans9 Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms. Neurosurgery 2008;62(1):183–94.
Referans10 Molyneux AJ, Kerr RSC, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus 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(9488):809–17.
Referans11 Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB. Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. J Neurointerv Surg 2011;4(3):182–9.
Referans12 Sharma M, Brown B, Madhugiri V, Cuellar-Saenz H, Sonig A, Ambekar S, Nanda Aet al. Unruptured intracranial aneurysms: comparison of perioperative complications, discharge disposition, outcome, and effect of calcification, between clipping and coiling: a single institution experience. Neurol India 2013;61(3):270–6.
Referans13 Koźba-Gosztyła M, Czapiga B, Jarmundowicz W, Tomiałowicz Ł. Unruptured intracranial aneurysms: surgery still safe as a treatment option. Adv Clin Exp Med 2016;25(5):911–6.
Referans14 Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology 2010;256(3):887–97.
Referans15 Eboli P, Ryan RW, Alexander JE, Alexander MJ. Evolving role of endovascular treatment for MCA bifurcation aneurysms: case series of 184 aneurysms and review of the literature. Neurol Res 2014;36(4):332–8.