Tratamiento endovascular de 473 aneurismas intracraneanos: resultados angiográficos y clínicos. Experiencia colombiana, 1996-2008
Palabras clave:
aneurisma intracraneal, hemorragia subaracnoidea, embolización terapéutica, indicadores de morbimortalidad, angiografía cerebral, hemorragias intracraneales
Resumen
Introducción. La terapia endovascular es una técnica aceptada mundialmente para el tratamiento de aneurismas cerebrales rotos y no rotos. En nuestro medio no hay grandes series publicadas que permitan comprobar la reproducibilidad del método según el grado de oclusión y la morbimortalidad de la técnica.Objetivo. Evaluar los resultados angiográficos y clínicos de la oclusión endovascular de 473 aneurismas intracraneanos tratados durante un período de 12 años.
Materiales y métodos. Se realizó un estudio retrospectivo en 376 pacientes con 473 aneurismas intracraneanos tratados por terapia endovascular entre los años 1996 y 2008. Se analizaron las imágenes angiográficas antes del procedimiento y después de él y se registró el estado clínico al momento de ser dado de alta, según la escala de coma de Glasgow. Se evalúo la morbimortalidad asociada con la técnica y los resultados angiográficos inmediatos.
Resultados. La factibilidad técnica del procedimiento fue de 96,8%. Según la escala de Hunt y Hess, al momento de la admisión, 8,7% de los pacientes estaban en el grado I, 35,7% en el grado II, 19,2% en el grado III y 7,8% en los grados IV o V. El 28,5% de los pacientes tenían aneurismas no rotos. Los resultados angiográficos inmediatos demostraron oclusión total en 69,6%, presencia de cuello remanente en 17,5% y oclusión parcial o fallida en 16,1% de los pacientes con "embolización". La mortalidad global fue de 10,4%, con una mortalidad del procedimiento de 1,5%. Se presentaron complicaciones asociadas con la técnica en 7,6% de los aneurismas tratados.
Conclusión. El tratamiento endovascular de los aneurismas intracraneanos se asoció con una baja morbimortalidad y una gran factibilidad técnica. Los resultados fueron similares a diversas series publicadas en la literatura mundial, respaldando la reproducibilidad del método en nuestro medio.
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Referencias bibliográficas
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16. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke. 2002;33:210-7.
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18. Vanninen R, Koivisto T, Saari T, Hernesniemi J, Vapalahti M. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils: a prospective randomized study. Radiology. 1999;211:325-36.
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20. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years experience. J Neurosurg. 2003;98:959-66.
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22. Vinuela F, Duckwiler G, Mawad M. Guglielmi G. Detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg. 1997;86:475-82.
23. Solander S, Ulhoa A, Vinuela F, Duckwiler GR, Gobin YP, Martin NA, et al. Endovascular treatment of multiple intracranial aneurysms by using GDC. J Neurosurg. 1999;90:857-64.
24. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, et al. A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol. 2005;26:1723-31.
25. International Subarachnoid Aneurysm Trial. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet. 2002;360:1267-74.
26. Sellar R. International Subarachnoid Aneurysm Trial (ISAT): preliminary report. Neurointerventionist. 2002;3:82.
27. Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 1968;28:14-20.
28. Gabrielsen TO, Greitz T. Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn. 1970;10:1-10.
29. Duke BJ, Kindt GW, Breeze RE. Outcome after urgent surgery for grade IV subarachnoid hemorrhage. Surg Neurol. 1981;54:146-50.
30. Gumprecht H, Winkler R, Gerstner W, Lumenta CB. Therapeutic management of grade IV aneurysm patients. Surg Neurol. 1997;47:54-9.
31. Kawanabe Y, Sadato A, Taki W, Hashimoto N. Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: Correlation between coil packing density and coil compaction. Acta Neurochir (Wien). 2001;143:451-5.
32. Piotin M, Mandai S, Murphy KJ, Sugiu K, Gailloud P, Martin JB, et al. Dense packing of cerebral aneurysms: An in vitro study with detachable platinum coils. AJNR Am J Neuroradiol. 2000;21:757-60.
33. Hope JK, Byrne JV, Molyneux AJ. Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol. 1999;20:391-9.
34. van Rooij WJ, de Gast A, Sluzewski M, Nijssen PC, Beute GN. Coiling of truly incidental intracranial aneurysms. AJNR Am J Neuroradiol. 2006;27:293-6.
35. Vindlacheruvu RR, Mendelow AD, Mitchell P. Risk-benefit analysis of the treatment of unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatr. 2005;76:234-9.
2. Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg. 1992;77:515-24.
3. Tevah J. Tratamiento endovascular de los aneurismas cerebrales: sus comienzos hace 30 años y su desarrollo actual. Rev Chil Radiol. 2003;9:78-85.
4. Ascensio JL, Vargas SA, Jiménez CM, Arias SA. Terapia endovascular en aneurismas vertebrobasilares. Experiencia del grupo neurovascular. Revista Colombiana de Radiología. 2006;17:1986-94.
5. Pascual-Lozano AM, Chamarro-Lázaro R, Soler-Markessinis F, Láinez-Andrés JM. Eficacia y seguridad del tratamiento endovascular de aneurismas cerebrales: experiencia en nuestro medio. Neurología. 2004;19:369-76.
6. Zubillaga A, Guglielmi G, Vinuela F, Duckwiler G. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatments results. AJNR Am J Neuroradiol. 1994;15:815-20.
7. Massoud T, Guglielmi G, Vinuela F, Duckwiler G. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. AJNR Am J Neuroradiol. 1996;17:549-54.
8. Cognard C, Pierot L, Boulin A, Weill A, Tovi M, Castaings L, et al. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology. 1997;202:783-92.
9. Pierot L, Boulin A, Castaing L, Rey A, Moret J. Selective occlusion of the basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery. 1996;38:948-54.
10. Cognard C, Weill A, Castaings L, Rey A, Moret J. Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology. 1998;206:499-510.
11. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, et al. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology. 1999;212:348-56.
12. Gruber A, Killer M, Bavinski G, Richling B. Clinical and angiographic results of endovascular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery. 1999;45:793-803.
13. Malisch TW, Guglielmi G, Vinuela F, Duckwiler G, Gobin YP, Martin NA, et al. Intracranial aneurysms treated with Guglielmi detachable coil: midterm clinical results in a consecutive series of 100 patients. J Neurosurg. 1997;87:176-83.
14. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert AM, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398-403.
15. Friedman JA, Douglas AN, Meyer FB. Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms: retrospective review of a 10-year single-center experience. AJNR Am J Neuroradiol. 2003;24:526-33.
16. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke. 2002;33:210-7.
17. Byrne JV, Sohn MJ, Molyneux AJ. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg. 1999;90:656-63.
18. Vanninen R, Koivisto T, Saari T, Hernesniemi J, Vapalahti M. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils: a prospective randomized study. Radiology. 1999;211:325-36.
19. Valle JN, Aymard A, Vicaut E, Reis M, Merland JJ. Endovascular treatment of basilar tip aneurysms with GDC: predictors of immediate and long-term results with multivariate analysis: 6-year experience. Radiology. 2003;226:867-79.
20. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years experience. J Neurosurg. 2003;98:959-66.
21. Henkes H, Fischer S, Weber W, Miloslavski E, Felber S, Brew S, et al. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery. 2004;54:268-80.
22. Vinuela F, Duckwiler G, Mawad M. Guglielmi G. Detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg. 1997;86:475-82.
23. Solander S, Ulhoa A, Vinuela F, Duckwiler GR, Gobin YP, Martin NA, et al. Endovascular treatment of multiple intracranial aneurysms by using GDC. J Neurosurg. 1999;90:857-64.
24. Gallas S, Pasco A, Cottier JP, Gabrillargues J, Drouineau J, Cognard C, et al. A multicenter study of 705 ruptured intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol. 2005;26:1723-31.
25. International Subarachnoid Aneurysm Trial. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet. 2002;360:1267-74.
26. Sellar R. International Subarachnoid Aneurysm Trial (ISAT): preliminary report. Neurointerventionist. 2002;3:82.
27. Hunt W, Hess R. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 1968;28:14-20.
28. Gabrielsen TO, Greitz T. Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn. 1970;10:1-10.
29. Duke BJ, Kindt GW, Breeze RE. Outcome after urgent surgery for grade IV subarachnoid hemorrhage. Surg Neurol. 1981;54:146-50.
30. Gumprecht H, Winkler R, Gerstner W, Lumenta CB. Therapeutic management of grade IV aneurysm patients. Surg Neurol. 1997;47:54-9.
31. Kawanabe Y, Sadato A, Taki W, Hashimoto N. Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: Correlation between coil packing density and coil compaction. Acta Neurochir (Wien). 2001;143:451-5.
32. Piotin M, Mandai S, Murphy KJ, Sugiu K, Gailloud P, Martin JB, et al. Dense packing of cerebral aneurysms: An in vitro study with detachable platinum coils. AJNR Am J Neuroradiol. 2000;21:757-60.
33. Hope JK, Byrne JV, Molyneux AJ. Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol. 1999;20:391-9.
34. van Rooij WJ, de Gast A, Sluzewski M, Nijssen PC, Beute GN. Coiling of truly incidental intracranial aneurysms. AJNR Am J Neuroradiol. 2006;27:293-6.
35. Vindlacheruvu RR, Mendelow AD, Mitchell P. Risk-benefit analysis of the treatment of unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatr. 2005;76:234-9.
Cómo citar
1.
Vargas SA, Herrera DA, Cornejo JW. Tratamiento endovascular de 473 aneurismas intracraneanos: resultados angiográficos y clínicos. Experiencia colombiana, 1996-2008. Biomed. [Internet]. 1 de diciembre de 2010 [citado 5 de abril de 2025];30(4):567-76. Disponible en: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/295
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2010-12-01
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