前交通动脉瘤血管内栓塞治疗

Endovascular treatment of intracranial anterior communicating artery aneurysm with coils

目的 总结以电解可脱性弹簧圈 (GDC)血管内栓塞治疗前交通动脉瘤的技术要点、并发症及其防治经验 ,并评价其治疗效果。方法 对 4 6例前交通动脉瘤患者采用经皮股动脉穿刺行全脑选择性血管造影术 ,应用GDC进行动脉瘤囊内栓塞 ;术后早期处理出血并有效的对症治疗。结果 成功栓塞 4 6个动脉瘤 ,其中 4 4例临床痊愈 ,2例死亡 ,死亡率 4 .3%。术中动脉瘤腔 10 0 %闭塞者 4 1例 ,95 %闭塞者 3例 ,90 %闭塞者 2例。术中动脉瘤破裂 1例 ,并发脑血栓 1例 ,并发脑血管痉挛 4例 ;术后无弹簧圈末端逸出 ,1例复发者经二次补充GDC栓塞而治愈。术后随访 3～ 5 0个月均无再出血。结论 对前交通动脉瘤采用GDC进行血管内囊内栓塞疗效可靠 ;早期诊断、早期治疗、正确处理术中并发症、提高栓塞技术及积极有效的术后处理是减少术后并发症、提高治愈率的重要方法。

Objective To summarize the techniques, managements a nd the complications of endovascular embolization on anterior communicating artery aneurysm with Guglielmi detachable coils (GDC), and to evaluate the effec t of treatment.Methods Forty-six cases were treated with GDC t o embolize the aneurismal sac via femoral artery approach. The hemorrhage wa s early removed from subarachnoid cavity after operation.Results Forty-six aneurysms were cured, forty-four patients recovered clinically, an d two patients died. The mortality was 4.3%. The 100% embolization was achi eved in the sacs of 41 aneurysms, 95% embolization in 3 ,and 90% embolization in 2 . One case of aneurysm reputured during the embolization. One case suf fered from cerebral embolism and four cases suffered from cerebral vasospasm. Th e microcoil had not escaped after operation. One recurring case was cured by sec ond GDC embolization. No rebleeding occurred in the 3 to 50 months' follow- up.Conclusion GDC occlusion is a safe and effective treatme nt for the anterior communicating artery aneurysm. Advances in the techniques an d correct treatment of the complications will decrease the complications and imp rove future outcome.