Clinical Study On Recurrent Low Grade Intracranial Aneurysm Treated With Surgical Clipping And Endovascular Embolization Treatment

Objective:1. To summarize clinical feathers of low grade aneurysms;2. To compare the recurrence rates of low grade intracranial saccular aneurysm treated with surgical clipping or endovascular embolization;3. To analyze the factors causing recurrence in cases of low grade ruptured intracranial saccular aneurysm treated with clipping surgery or endovascular coiling.Materials and Method:420patients with474intracranial ruptured saccular aneurysms were treated in our department from January2009to July2012, male174cases, female246cases, the average age was (51.00±10.73),124aneurysms were located in the anterior communication artery,30in the anterior cerebral artery,88in the mediate cerebral artery,126in the posterior communication artery,60in the carotid artery,32in the posterior circle,14in the anterior choroidal artery, the average size was (6.17±4.12) mm, the neck size of the aneurysms was about (3.64±2.15) mm,282cases were treated with clipping surgery, fluorescence fundus angiography was used after the surgery,192cases were treated with endovascular coiling, angiographic was used after the therapy to evaluate the coiling degree, follow-up DSA was performed in the period of42months after procedure in all patients, and the recurrence factors were classified and the relationship between factors including age, gender, coiling degree, location, neck, size, coiling materials, coiling method, and hypertension history, and the recurrence of aneurysm was analyzed with SPSS18.0.Results: 1. From the results of follow-up after3to42months, no any cases with rebleeding or new neurologic impairment, the recurrence rate was0.7%(2/282) and17.19%(33/192) in surgical clipping group and endovascular coiling group, respectively. The recurrence rate in surgical clipping group was lower(p<0.05);2. Surgical clipping group:two recurrent cases, residues of neck were the major factors of recurrence for surgical clipping patients;3. Endovascular coiling group:the factors including gender, coiling degree, location of aneurysm, tumor neck, coiling materials and coiling methods were related to the recurrence for endovascular coiling patients(P<0.05), in which location (P=0.012, OR=84.370), neck (P=0.009, OR=5.968), coiling materials (P=0.006, OR=4.940)and coiling methods(P=0.002, OR=11.061) were independent risk factors for recurrence.Conclusion:1. For low grade cerebral aneurysm, microsurgical clipping and endovascular coiling can significantly prevent rebleeding, and for better results. Recurrence rate in surgical clipping group was lower than endovascular embolization group.2. Incomplete clipping was the major factors of recurrence for surgical clipping patients.3. The factors including neck, coiling materials and coiling methods were related to the recurrence for endovascular coiling patients.4. Immediate angiography after treatment is effective, a long-term DSA follow-up is an important standard to evaluate the effect after therapy, but copy the foreign models completely is difficult in our country, the re-therapeutic strategies should be specialized according to the forms and characteristics of recurrence; and following up on a regular basis and treated in a timely manner is the key to prevent the rebleeding of cerebral aneurysm.