颅内宽颈动脉瘤的血管内治疗

The Endovascular Treatment of Wide-necked Intracranial Aneurysm

目的:评价介入治疗颅内宽颈动脉瘤的临床效果,选择有效的手术方式。方法:回顾性分析介入治疗的31例颅内宽颈动脉瘤(瘤颈∶体大于0.5)手术方式及效果。结果:1.14例瘤颈∶体0.5～0.7者均接受单纯三维(3D)弹簧圈栓塞,术中12例栓塞率大于90%,2例小于90%。7例复查,6例100%栓塞。2.11例瘤颈∶体0.7～0.9。①2例接受单纯3D弹簧圈栓塞,术中栓塞率大于90%,1例复查,100%栓塞;②1例接受单纯3D弹簧圈栓塞失败,采用BAGDC技术,术中栓塞率大于90%,未复查;③1例接受单纯3D弹簧圈栓塞失败后采用双导管技术部分栓塞,术中栓塞率小于90%,复查,瘤腔仍部分残留;④7例接受二期支架辅助弹簧圈栓塞,3例栓塞率大于90%,4例栓塞率小于90%。4例复查100%栓塞。3.6例瘤颈∶体≥1.0。①4例接受支架辅助弹簧圈栓塞,术中2例栓塞率大于90%,2例栓塞率小于90%。2例复查,1例瘤腔100%栓塞,1例瘤腔仍部分残留;②2例微小宽颈动脉瘤使用Neuroform支架覆盖瘤颈,术中均有造影剂残留,术后复查瘤腔均消失。结论:对颅内瘤颈∶体0.5～0.7的宽颈动脉瘤,单纯应用3D弹簧圈栓塞可获成功。对瘤颈∶体≥0.7者应采取单纯血管内支架植入或血管内支架结合弹簧圈栓塞。

Objective:To evaluate clinic effect of endovascular treatment for wide-necked intracranial aneurysms,and to choose effective operation technique.Methods:Endovascular methods and effect of thirty-one wide-necked aneurysms that the ratio of neck/body was more than 0.5 in thirty-one patients were analyzed retrospectively.Results:1.Fourteen aneurysms that the ratio of neck/body was between 0.5～0.7 were coiled with 3D coil only.Twelve aneurysms were embolized more than 90% and 2 aneurysms were embolized less tha...