İntrakranyal anevrizmalarda biyoaktif koil (Matriks) ile embolizasyon
Embolization of intracranial aneurysm with bioactive coils (Matrix)
Yazar: HARUN ÖZER
Danışman: PROF. DR. NACİ KOÇER
İstanbul Üniversitesi / Cerrahpaşa Tıp Fakültesi / Radyodiagnostik Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2009
Konu: Nöroşirürji = Neurosurgery ; Radyoloji ve Nükleer Tıp = Radiology and Nuclear Medicine
Dizin: Anevrizma = Aneurysm

Özet:
Amaç: Anevrizma boynundaki fibrotik reaksiyonu artıran ve embolizasyonun kalıcı olması amacıyla dizayn edilen biyoaktif materyal örneklerin den Matriks koil ile embolizasyonu yapılan orta dönem takiplerini elde ettiğimiz olguları sunacağız.Gereç ve Yöntem:Bu çalışmaya 2002-2006 yılları arasında sadece Matriks koil kullanılan 74 olguda ki 80 anevrizma embolizasyonu dahil edilmiştir. 46 olgu kanamış ve 28 i insidentaldir. 41 anevrizma dar boyunlu ve küçük (<10 mm) boyun (<4 mm) ; 7 si dar boyunlu büyük, 14 ü geniş boyunlu küçük (>/=4 mm); 16 sı geniş boyunlu büyük (10-25 mm);ve ikisi dev anevrizmalardan oluşmaktaydı (>25 mm). Embolizasyon tekniği standart koiller de uygulanan ile aynıdır.Bulgular:Tedavi sonrası anjiyografilerde olguların %70 inde total oklüzyon, % 24 ünde kulakçık tarzında dolum ve % 6 sında rezidü boyun dolumu sağlanmıştır. Takip anjiyografiler 57 anevrizma için yapılmış olup takip süreleri 6 ay ile 2 yıl arasındadır. Toplam rekanalizasyon oranı % 24. Alt gruplara bakıldığında küçük boyunlu anevrizmalarda % 15; geniş boyunlu olgularda % 38 dir. Dev anevrizmaların ise tamamı rekanalize olmuştur. Balon modelleme yapılan 29 olgunun 7 sinde (% 25), balon modelleme kullanılmayan 28 olgunun ise 10 unda (%35 ) rekanalizasyon izlenmiştir. Prosedüre bağlı morbidite ve mortalite oranları % 16 ve % 2.6 dır.Sonuç: Matriks koil güvenilir bir materyal olmakla birlikte standart koil embolizasyon oranlarına göre daha iyi rekanalizasyon oranları elde edilememiştir.

Abstract:
Background And Purpose: Endovascular treatment of intracranial aneurysms using platinum coils is effective, but not uncommonly aneurysms recur. New-generation coils, such as Matrix, aim to address this problem. This study examines the safety and efficacy of these coils in the treatment of both ruptured and unruptured aneurysmsMaterıals And Methods: Seventy-four patients with 80 aneurysms were included in the study. Forty-six aneurysms were ruptured and 28 were incidental. Of these, all were treated exclusively with the new polyglycolic acid (PGA)-containing coils. Initial and follow-up angiograms were graded according to Raymond classification. Follow-up angiography was available in 57 aneurysms. Forty-one aneurysms were small with (<10 mm) small neck (<4 mm), 7 were small with large neck (>/=4 mm); sixteen were large (10-25 mm) with large neck (>/=4 mm); fourteen were small (<10 mm) with large neck and two were giant (>25 mm). The embolization technique was the same with that in standard bare coiling. Results: : Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 70%, dog ear in 24% and residue neck in 6%. Follow-up angiography was obtained in 57 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 24%, and the re-treatment rate was 14%; in the subgroup analysis, recanalization rates were 15 % in small neck; 38 % in wide neck. Two giant aneurysms also showed recanalization. Recanalization rate was lower in balloon remodelling group than non-remodelling group (%25 vs %36). Procedure-related morbidity and mortality rates were 16 % and 2.6%, respectively. Analysis of the follow-up angiograms showed 40 (70%) had stable occlusion, 2 (3.3%) had improved occlusion, and 15 (26%) had worsening occlusion. There were no rebleeds in the follow-up period.Analysis of the follow-up angiograms showed 40 (70%) had stable occlusion, 2 (3.3%) had improved occlusion, and 15 (26%) had worsening occlusion. There were no rebleeds in the follow-up period.Conclusion: Eventhough PGA-containing coils (Matrix) are safe to use, the recanalization rate achieved was not superior to bare platinum coils in the mid-term.