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Master Thesis

Histoire naturelle des anévrismes intracrâniens déjà traités : risque de saignement et risque de retraitement

Abstract : Intracranial aneurysms (IAs) are vascular malformations that occur frequently and can be treated through endovascular treatment (EVT) or microsurgery. A previously treated IA can recanalize, which can lead to a rupture. The aim of our study was to evaluate the natural history of previously treated IA, by evaluating the risk of ruptures and the risk of retreatment. All patients treated for an IA between 2007 and 2017 in 4 hospitals were included. The rate of (recurrent) haemorrhage and the rate of prophylactic retreatment, as well as the risk factors of haemorrhage, were retrospectively evaluated. Finally, we evaluated the frequency of procedural complications of IA retreatment and searched for any risk factors. A total of 4997 IA were included in the study, corresponding to 20489 patients-years. Compared with microsurgery, EVT leads to a higher risk of retreatment but leads to a similar risk of haemorrhage. Twenty-eight patients (0.6%) had haemorrhage, and recanalization after clipping was the only risk factor. A total of 237 IAs (4.7%) were retreated. Among them, 29 (12.2%) had a complication. The only risk factor for complications was microsurgical clipping used as an aneurysm retreatment. The rate of haemorrhage of previously treated IAs is low, and predicting the occurrence of haemorrhage is difficult. Additionally, IA retreatment is frequent, particularly with EVT, and the frequency of procedural complications is important. The imbalance between the rate of haemorrhage and that of retreatment raises the question of what the indications for IA retreatment should be.
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Submitted on : Thursday, September 17, 2020 - 3:10:07 PM
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  • HAL Id : dumas-02942029, version 1


Thomas Metayer. Histoire naturelle des anévrismes intracrâniens déjà traités : risque de saignement et risque de retraitement. Médecine humaine et pathologie. 2020. ⟨dumas-02942029⟩



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