Título :	A influência do número de molas destacáveis na taxa de oclusão dos aneurismas cerebrais submetidos à embolização percutânea : estudo caso controle
Autor :	Sousa, Emerson Brandão
Orientador(es)::	Kessler, Iruena Moraes
Assunto::	Aneurisma intracraniano Molas destacáveis Embolização Aneurisma cerebral
Fecha de publicación :	2-abr-2019
Data de defesa::	25-jul-2018
Citación :	SOUSA, Emerson Brandão. A influência do número de molas destacáveis na taxa de oclusão dos aneurismas cerebrais submetidos à embolização percutânea: estudo caso controle. 2018. 171 f., il. Tese (Doutorado em Ciências Médicas)—Universidade de Brasília, Brasília, 2018.
Abstract:	Introduction Subarachnoid hemorrhage is one of the major public health problems and a significant cause of morbidity and mortality worldwide. Cerebral aneurysm is its main cause. Treatment consists of occluding the aneurysm and maintaining vascularization in the vessels adjacent. Detachable coil embolization was introduced in 1995 and was used as an alternative to the treatment. Since then, an embolization has become increasingly popular and presenting advances in technique and improved embolic material, however it still a lower rate of occlusion and a higher retreatment rate when compared to clipping. Objective To determine characteristics of aneurysms that permomed coil embolization and which features of coils are available to choose in embolization schedule that may influence the recanalization rate of the coil embolization. Method Datas recorded between February 2010 and December 2015 at a single center (São Marcos Hospital – Teresina/Brazil). Aneurysms that performed coil embolization were included in this study. For the included cases, we retrospectively reviewed the medical history, endovascular procedure and angiographic aspects, such as age, sex, aneurysm location, aneurysm rupture, aneurysm shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume (height × length × width × π/6 mm3), coil volume (square of primary diameter × length × π/4 mm3), VPD (total coil volume/calculated aneurysm volume × 100 %), 1st VPD (first coil volume/calculated aneurysm volume × 100 %), 1st LD (<maximum aneurysm size and ≥maximum aneurysm size), relation of the first loop diameter of the first coil and the maximum aneurysm size (RLAS, first loop diameter/maximum aneurysm size × 100 %), the type of assistance technique chosen (stent, balloon or both), the Raymond scale score at the initial and follow-up angiographies and recanalization. Ethics approval was obtained from the local institutional review board, and the board waived the need for patient consent. Results A total of 174 saccular aneurysms in 171 patients were evalautade. Mean patient age of 53.7 ± 12.5 years. Women represented 85.6% (149) of the cases. The aneurysms were located in the anterior circulation in 94.3% of the cases. Of the 174 aneurysms, 118 (67.8%) ruptured. There were 130 (74.7%) aneurysms with a regular shape. The aneurysms had a maximum aneurysm size of 8.0 ± 5.4 mm. The mean coil volume was 81.1 ± 147.3 mm3 . The mean VPD, 1st VPD, 1st LD and RLAS were 58.9 ± 27.1%, 22.7 ± 19.7%, 7.3 ± 5.2 mm and 93.1 ± 36.3%, respectively. In 41 (23.6%) cases, there was a worsening of angiographic obliteration (recanalization). The factors associated with recanalization were irregular shape (P = 0.025), maximum aneurysm size (P < 0.001), neck width (P=0.011), dome-to-neck ratio (P<0.001), aneurysm volume (P < 0.001), first loop diameter of the first coil smaller than the maximum aneurysm size (P=0.002), VPD (P<0.001) and 1st VPD (P<0.001). The cut-off values calculated for recanalization were 92% for RLAS, 11% for 1st VPD and 55% for VPD. Conclusion Factors associated with recanalization rate werw the aneurysm irregular shape, the largest aneurysm size, the aneurysm neck size, the domus-neck ratio, the aneurysm volume, the diameter of the first loop of the first spring smaller than the largest aneurysm size , the VPD and the 1st VPD. A first VPD was recently associated with recanalization and this is the first study that to associated the 1st LD and the rate of recanalization.
metadata.dc.description.unidade:	Faculdade de Medicina (FM)
Descripción :	Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2018.
metadata.dc.description.ppg:	Programa de Pós-Graduação em Ciências Médicas
Licença::	A concessão da licença deste item refere-se ao termo de autorização impresso assinado pelo autor com as seguintes condições: Na qualidade de titular dos direitos de autor da publicação, autorizo a Universidade de Brasília e o IBICT a disponibilizar por meio dos sites www.bce.unb.br, www.ibict.br, http://hercules.vtls.com/cgi-bin/ndltd/chameleon?lng=pt&skin=ndltd sem ressarcimento dos direitos autorais, de acordo com a Lei nº 9610/98, o texto integral da obra disponibilizada, conforme permissões assinaladas, para fins de leitura, impressão e/ou download, a título de divulgação da produção científica brasileira, a partir desta data.
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