Rüptüre olmuş intrakranial anevrizmalarda woven endobridge tedavisinin etkinliğinin değerlendirilmesi
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Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Rüptüre olmuş intrakranial anevrizma nedeniyle subaraknoid kanama gelişen
hastaların tedavisinde çeşitli alternatifler bulunmaktadır. Çalışmamızda woven endobridge
cihazı ile tedavi edilen rüptüre olmuş anevrizması bulunan hastaların klinik sonuçlarını ve
oklüzyon oranlarını değerlendirerek tecrübelerimizi sunmayı amaçladık.
Gereç ve Yöntem: Aralık 2015-Mayıs 2022 tarihleri arasında hastanemize intrakranial
anevrizmaya bağlı subaraknoid kanama ile başvuran ve girişimsel radyoloji departmanında
WEB ile tedavi edilen 41 hastaya ait 42 anevrizma çalışmaya dahil edilmiştir. Tedavi sonrası
ortalama 15 ay (aralık 1-83 ay) takip edilen hastaların Manyetik Rezonans anjiyografi ve dijital
subtraksiyon anjiyografisi ile oklüzyon oranları ve 1. yıl takiplerinde modifiye Rankin
Skorlaması ile klinik iyileşme durumları değerlendirilmiştir.
Bulgular: Araştırmaya alınan hastaların 18’i erkek, 23’ü kadın (ortalama yaş: 53;
aralık: 33–83) hastaya ait rüptüre olmuş 42 anevrizma WEB ile tedavi edildi Anevrizmaların
ortalama çapı 5.3 mm, çap aralığı ise 3-10 mm’dir. Boyun genişliği ortalama 3.94 mm, aralık
ise 2-7 mm idi. Anevrizmaların tamamı geniş boyunluydu (4 mm ve daha geniş boyunlu
ve/veya kubbe/boyun oranı≤1,6 anevrizmalar). Anevrizmaların 17’si (%40) AComA, 14’ü
(%33) MCA, 6’sı (%14) baziler tepe, 2’si (%5) ACA, 1’i (%2) İCA tepe, 1’i (%2) PİCA, 1’i
(%2) PComA lokalizasyonunda yerleşmişti. Tüm hastalarda cihaz başarılı bir şekilde
yerleştirilmiştir. Takip incelemeleri olan 25 hastanın 23‘ünde (%92) yeterli oklüzyon tespit
edilmiştir. İki hastada anevrizma kalıntısı saptanmış ve hastalara tedavi önerilmiştir. Uzun
dönem takiplerinde 13 hasta hayatını yitirmiştir. 17 hastada asemptomatik bir şekilde hayatına
devam etmektedir (mRS 0). 7 hastada ise iyi klinik sonuç (mRS 1-2) mevcuttur. Hastalarda
tedaviye bağlı morbidite ya da mortalite saptanmamıştır.
Sonuç: WEB cihazının rüptüre olmuş, geniş boyunlu anevrizmalarda akut oklüzyon
oluşturması, işlem sonrası antiplatelet tedavi gerektirmemesi, kısa ve uzun dönem takiplerinde
yeterli oklüzyon sağlaması, rekanalizasyon oranlarının düşük olması sebebiyle uygun
anevrizmalarda efektif bir tedavi seçeneği olduğu görülmektedir. Morbidite-mortalite
oranlarının düşük olması, intraoperatif rüptür ve tromboembolik komplikasyonların az
görülmesi güvenli bir tedavi yöntemi olduğunu doğrulamaktadır.
Purpose: There are various alternatives in the treatment of patients who develop subarachnoid hemorrhage due to a ruptured intracranial aneurysm. In our study, we aimed to present our experience by evaluating the clinical results and occlusion rates of patients with ruptured aneurysm treated with a woven endobridge device. Materials and Methods: Between December 2015 and May 2022, 42 aneurysms belonging to 41 patients who applied to our hospital with subarachnoid hemorrhage due to intracranial aneurysm and were treated with WEB in the interventional radiology department were included in the study. The occlusion rates of the patients, who were followed up for an average of 15 months (range 1-83 months) after treatment, were evaluated with Magnetic Resonance angiography and digital subtraction angiography and their clinical improvement was evaluated with the modified Rankin Score at the 1st year follow-up. Results: 42 ruptured aneurysms of 18 male and 23 female (mean age: 53; range: 33 to 83) patients included in the study were treated with WEB. The mean diameter of the aneurysms is 5.3 mm and the diameter range is 3-10 mm. The mean neck width was 3.94 mm and the range was 2-7 mm. All of the aneurysms had wide necks (aneurysms with a neck of 4 mm and larger and/or a dome/neck ratio ≤1.6). Of the aneurysms, 17 (40%) AComA, 14 (33%) MCA, 6 (14%) basilar tip, 2 (5%) ACA, 1 (2%) ICA crest, 1' i (2%) PICA was located in 1 (2%) PComA localization. The device was successfully placed in all patients. Adequate occlusion was detected in 23 (92%) of 25 patients with follow-up examinations. Aneurysm remnants were detected in two patients and treatment was recommended to the patients. In the long-term follow-up, 13 patients died. 17 patients continue their lives asymptomatically (mRS 0). 7 patients had good clinical results (mRS 1-2). No treatment-related morbidity or mortality was detected in the patients. Conclusion: The WEB device seems to be an effective treatment option in ruptured, wide-necked aneurysms as it creates acute occlusion, does not require post-procedure antiplatelet therapy, provides adequate occlusion in short and long-term follow-ups and has low recanalization rates. Low morbidity-mortality rates, low incidence of intraoperative rupture and thromboembolic complications confirm that it is a safe treatment method.
Purpose: There are various alternatives in the treatment of patients who develop subarachnoid hemorrhage due to a ruptured intracranial aneurysm. In our study, we aimed to present our experience by evaluating the clinical results and occlusion rates of patients with ruptured aneurysm treated with a woven endobridge device. Materials and Methods: Between December 2015 and May 2022, 42 aneurysms belonging to 41 patients who applied to our hospital with subarachnoid hemorrhage due to intracranial aneurysm and were treated with WEB in the interventional radiology department were included in the study. The occlusion rates of the patients, who were followed up for an average of 15 months (range 1-83 months) after treatment, were evaluated with Magnetic Resonance angiography and digital subtraction angiography and their clinical improvement was evaluated with the modified Rankin Score at the 1st year follow-up. Results: 42 ruptured aneurysms of 18 male and 23 female (mean age: 53; range: 33 to 83) patients included in the study were treated with WEB. The mean diameter of the aneurysms is 5.3 mm and the diameter range is 3-10 mm. The mean neck width was 3.94 mm and the range was 2-7 mm. All of the aneurysms had wide necks (aneurysms with a neck of 4 mm and larger and/or a dome/neck ratio ≤1.6). Of the aneurysms, 17 (40%) AComA, 14 (33%) MCA, 6 (14%) basilar tip, 2 (5%) ACA, 1 (2%) ICA crest, 1' i (2%) PICA was located in 1 (2%) PComA localization. The device was successfully placed in all patients. Adequate occlusion was detected in 23 (92%) of 25 patients with follow-up examinations. Aneurysm remnants were detected in two patients and treatment was recommended to the patients. In the long-term follow-up, 13 patients died. 17 patients continue their lives asymptomatically (mRS 0). 7 patients had good clinical results (mRS 1-2). No treatment-related morbidity or mortality was detected in the patients. Conclusion: The WEB device seems to be an effective treatment option in ruptured, wide-necked aneurysms as it creates acute occlusion, does not require post-procedure antiplatelet therapy, provides adequate occlusion in short and long-term follow-ups and has low recanalization rates. Low morbidity-mortality rates, low incidence of intraoperative rupture and thromboembolic complications confirm that it is a safe treatment method.
Açıklama
Anahtar Kelimeler
İntrakranial anevrizma, Woven endobridge (WEB), Subaraknoid kanama (SAK), Endovasküler tedavi, Intracranial aneurysm, Woven endobridge (WEB), Subarachnoid hemorrhage (SAH), Endovascular treatment
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yazar, M. E. (2023). Rüptüre olmuş intrakranial anevrizmalarda woven endobridge tedavisinin etkinliğinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Radyoloji Anabilim Dalı, Konya.
