电解可脱性弹簧圈栓塞治疗破裂性颅内动脉瘤

Complications and countermeasures in acute rupture intracranial aneurysm embolization with guglielmi detachable coil

目的 探讨电解可脱性弹簧圈介入栓塞治疗急性破裂性颅内动脉瘤的并发症及其防治。方法 在数字减影全脑血管造影 (DSA)监视下 ,经股动脉 ,采用电解可脱性弹簧圈 (GDC)栓塞治疗 14 6例急性破裂性颅内动脉瘤患者。结果 成功栓塞达 10 0 %有 136例 (93% ) ,栓塞达 90 %以上 9例 (6 % ) ,栓塞达 90 %以下 1例 (1% )。全组手术死亡 4例 (2 7% ) ;术中动脉瘤再破裂出血 9例 ,载瘤动脉痉挛 4例 ,GDC外逸 4例 ,血栓形成 2例 ,过度栓塞 2例 ,术后并发壳核高血压脑出血 2例 ,并发症发生率 15 8% ,成功率 84 2 %。结论 术者对颅内动脉瘤和载瘤动脉解剖关系的正确认识 ,栓塞技术的提高 ,术中、术后发生并发症的正确处理 ,栓塞材料的改进 ,这些是减少并发症及改善预后的关键。

Objective To explore the complications and countermeasures in acute rupture intracranial aneurysm embolization with guglielmi detachable coil (GDC).Methods 146 patients with acute rupture intracranial aneurysm were embolized with GDC under the digital subtration angiography(DSA) imaging .Results Total occlusion was achieved in 136 cases (93%),over 90% in 9 cases(6%),less than 90% in one cases(1%). 4 patients died (2.7%); 9 rebleeded in the surgery;the parent artery were constricted in 4 cases; GDC escaped in 4 cases, 2 had over embolizations, 2 had thromboses; and 2 had hypertension hemorrhage after surgery.The rate of complications was 15.8%, and success rate 84.2%. Conclusion Better understanding of aneurysm and its parent artery angioanatomy, skill in embolization technique, correct judgment during treatment and improved embolic material are helpful to reduce the complications.