Journal of Korean Neurosurgical Society

  • 제60권6호
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  • Pages.644-653
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  • 2017
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Simple Coiling versus Stent-Assisted Coiling of Paraclinoid Aneurysms : Radiological Outcome in a Single Center Study

  • Kim, Soo Yeon (Department of Neurosurgery, Konkuk University Medical Center) ;
  • Park, Dong Sun (Department of Neurosurgery, Konkuk University Medical Center) ;
  • Park, Hye Yin (Institute of Environmental Medicine, Seoul National University College of Medicine) ;
  • Chun, Young Il (Department of Neurosurgery, Konkuk University Medical Center) ;
  • Moon, Chang Taek (Department of Neurosurgery, Konkuk University Medical Center) ;
  • Roh, Hong Gee (Department of Radiology, Konkuk University Medical Center)
  • 투고 : 2017.06.19
  • 심사 : 2017.09.25
  • 발행 : 2017.11.01
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초록

Objective : Paraclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms. Methods : Data of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups : simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results. Results : Complete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005-0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106-9.302). Conclusion : Use of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.

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참고문헌

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  1. Loop microcatheter technique for coil embolization of paraclinoid aneurysms vol.160, pp.9, 2017, https://doi.org/10.1007/s00701-018-3642-5
  2. Hemodynamic Characteristics Associated With Paraclinoid Aneurysm Recurrence in Patients After Embolization vol.10, pp.None, 2017, https://doi.org/10.3389/fneur.2019.00429
  3. Progressive thrombosis of unruptured aneurysms after coil embolization: analysis of 255 consecutive aneurysms vol.11, pp.11, 2017, https://doi.org/10.1136/neurintsurg-2019-014775
  4. Endovascular Treatment for Lateral Wall Paraclinoid Aneurysms and the Influence of Internal Carotid Artery Angle vol.61, pp.4, 2017, https://doi.org/10.2176/nmc.oa.2020-0307