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Evaluacija bezbednosti i uspešnosti koil embolizacije intrakranijalnih aneurizmi
Evaluation of safety and successfulness of the coil embolization of intracranial aneurysms
aUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za radiologiju, nuklearnu medicinu i onkologiju, Srbija bUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Katedra za hirurgiju, Srbija
e-adresa: opancina.valentina@gmail.com
Projekat: This work was supported by grant from the Faculty of Medical Sciences, University of Kragujevac (project JP 03-13)
Sažetak
Intrakranijalne aneurizme su problem kako za neurohirurge, tako i za interventne neuroradiologe zbogsvog morbiditeta i mortaliteta. Metoda izbora za lečenje nerupturiranih i rupturiranih intrakranijalnih aneurizmi je endovaskularni koiling zbog minimalne invazivnosti i visoke efikasnosti. Cilj naše studije je bio da se proceni bezbednost i uspešnost procedure endovaskularnog koilovanja kod nerupturiranih i ruptiranih intrakranijalnih aneurizmi. Naša studija je dizajnirana kao serija slučajeva i sastojala se od pacijenata starijih od 18 godina, koji su podvrgnuti endovaskularnom koilovanju nerupturiranih i rupturiranih intrakranijalnih aneurizmi i naknadnom pregledu 6 meseci nakon interventne procedure. Procedure su sprovedene od decembra 2010. do decembra 2016. godine od strane iskusnih interventnih neuroradiologa (više od 400 izvedenih embolizacija) na Odeljenju za interventnu neuroradiologiju Kliničkog centra Kragujevac, Srbija. Bilo je 681 pacijenta lečenih endovaskularnim koilovanjem (prosečna starost 47.5 ± 11.2 godina), od kojihje 324 (234 žena, 90 muškaraca) imalo nerupturiranu intrakranijalnu aneurizmu, a 357 (138 žena, 219 muškaraca) je imalo rupturiranu intrakranijalnu aneurizmu. U našoj seriji, ukupna stopa komplikacija bila je 11.71%. Analiza rezultata nakon prve endovaskularne procedure pokazala je da je kompletna okluzija aneurizme izvršena kod 546 pacijenata (80.3%), skoro-kompletna okluzija kod 81 pacijenta (11.8%) i nepotpuna okluzija kod 54 pacijenta (7.9%). Naši rezultati su zadovoljavajući u pogledu uspeha, bezbednosti, ishoda i studijskog materijala. Međutim, dodatni tehnički razvoj materijala i stalna obuka interventnih radiologa su neophodni u cilju poboljšanja ishoda lečenja i koristi pacijenata.
Abstract
Intracranial aneurisms are ongoing problem for neurosurgeons and especially for interventional neuroradiologists due to its morbidity and mortality. The method of choice for treatment of the unruptured and ruptured intracranial aneurysms is endovascular coiling on account of its minimal invasiveness and high effectiveness. The aim of our study was to evaluate the safety and successfulness of endovascular coiling procedure in unruptured and ruptured intracranial aneurysms. Our study was designed as case series and consisted of patients older than 18 years, who underwent endovascular coiling of unruptured and ruptured intracranial aneurysms and follow-up examination 6 months after the interventional procedure. The procedures were performed from December 2010 to December 2016, by experienced interventional neuroradilogists (more than 400 performed embolizations each) at the Department for Interventional Neuroradiology, Clinical Center Kragujevac, Serbia. There were 681 patients (average age 47.5 ± 11.2 years) treated with endovascular coiling, out of them 324 (234 females, 90 males) had unruptured intracranial aneurysm and 357 (138 females, 219 males) had ruptured intracranial aneurysm. In our series, total complication rate was 11.71%. Analysis of the results after first endovascular procedure has shown that complete aneurysm occlusion was accomplished in 546 patients (80.3%), near-complete in 81 patients (11.8%), and incomplete in 54 patients (7.9 %). Our results were satisfying regarding the procedure's success, safety, outcomes and study material. However, further technical development of the materials and constant training of the interventional radiologists, are a necessity in order to improve treatment outcomes and patients' benefit.
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