Endovaskularno liječenje intrakranijskih aneurizmi zavojnicama uz ugradnju potpornice

doctoral thesis

• Title (english): Endovascular treatment of intracranial aneurysms with stent assisted coiling
• Author: David Ozretić; MBZ: 347893
• Mentor: Marko Radoš (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2015-01-29, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Cilj liječenja intrakranijskih aneurizmi sprječavanje je rupture. Dugo vremena jedini
izbor bio je neurokirurški zahvat postavljanja kopče na vrat aneurizme kojom se ona
isljučuje iz cirkulacije, no određeni broj pacijenata nije bio pogodan za operativni
zahvat pa se kao alternativa prije 20-ak godina razvila endovaskularna tehnika
embolizacije aneurizmi zavojnicama kojima se ispunjava aneurizma.
Dosadašnja istraživanja pokazala su bolje kliničke ishode embolizacijske tehnike i
manju učestalost komplikacija, no primijećen je veći postotak rekanalizacije, tj.
ponovnog ulaska krvi u aneurizmu, zbog čega su potrebne češće kontrole i
dugotrajnije praćenje. Da bi se poboljšali dugoročni rezultati, počele su se kao
pomoćna sredstva upotrebljavati potpornice koje omogućavaju bolje punjenje
zavojnicama aneurizmi velikog promjera i širokog vrata, a imaju i dodatni učinak
preusmjeravanja krvi mimo aneurizme i poticanja cijeljenja vrata.
U ovom istraživanju promatrana su demografska, klinička i anatomska obilježja
bolesnika i aneurizmi liječenih endovaskularnom tehnikom embolizacije samo
zavojnicama i uz ugradnju potpornice te je ocijenjen dugoročni morfološki ishod
liječenja na kontrolnim angiografskim pregledima. Utvrđeno je da endovaskularni
zahvat embolizacije intrakranijske aneurizme zavojnicama uz ugradnju potpornice
nema veći postotak angiografski detektiranih proceduralnih komplikacija od
embolizacija samo zavojnicama i da ugradnja potpornice značajno smanjuje
učestalost perzistentnoga rezidualnog punjenja aneurizme tijekom vremena praćenja,
no ne i učestalost recidiva u odnosu na zahvat embolizacije samo zavojnicama.

Abstract (english)

The aim of intracranial aneurysm treatment is prevention of rupture. For a long time
only option was neurosurgical procedure of clipping the aneurysm neck for exclusion
from circulation, but certain number of patients were unfavourable for operation. In
the last 20 years endovascular technique of embolization with coils (coiling) was
developed as an alternative and solution for those patients. Published investigations
have shown better results of embolization procedures with lower rates of
complications, but higher rate of recanalization, i.e. reentering of blood into the
aneurysm, was observed that requires more controls and longer follow-up. To
improve long-term results, stents have been used as a supporting device to allow
better filling of large and wide neck aneurysms with coils, with additional effect of
diverting blood flow from the aneurysm and promotion of aneurysm neck healing.
In this research demographic, clinical and anatomical parameters of patients and
aneurysms treated with non assisted or stent assisted coiling were assessed, and
long-term morphological outcome was evaluated on control angiographic exams. It
was established that endovascular treatment with stent assisted coiling does not
have higher rate of angiographicaly detected procedural complications than non
assisted coiling, and that use of stent significantly reduces the rate of persistent
residual filling of aneurysm lumen during follow-up period, but does not reduce the
rate of recurrence compared to non assisted coiling.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:745773
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 76 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:30:10