前交通动脉瘤血管内栓塞治疗

Endovascular treatment of intracranial anterior communicating artery aneurysm with microcoils

目的总结41例前交通动脉瘤血管内栓塞治疗的经验和体会.方法对41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,应用微弹簧圈进行动脉瘤囊内栓塞;术后早期处理出血和有效的对症治疗.结果成功栓塞43个动脉瘤,其中40例临床痊愈,1例死亡,死亡率2.4%.术后动脉瘤腔100%闭塞者36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8例,术后弹簧圈末端逸出1例,1例复发者经二次补以微弹簧圈栓塞而治愈.术后随访3～30个月均无再出血.结论对前交通动脉瘤采用微弹簧圈进行血管内栓塞疗效可靠;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 treatment experience of 41 - case anterior aneurysms embolized with microcoils. Methods Forty- one cases were treated with coils to block the aneurysmal sac via femoral artery approach. The hemorrhage was early removed from subarachnoid cavity after operation. Results Forty- three aneurysms were cured, forty patients recovered clinically, and one patient died. The mortality was 2.4%. The 100% embolization was achieved in the sacs of 36 aneurysms, 95% embolization in 3 and 90% embolization in 2. One cases aneurysm ruptured during the embolization. One case suffered from cerebral embolism and 8 cases suffered from cerebral vasospasm. The microcoil of one case partially escaped after operation. One recurrent case was cured by second embolization. No reblceding occurred in the 3 to 30 months＇ follow up. Conclusion Microcoil occlusion is safe and effective treatment for the anterior communicating artery aneurysm. Advances in the techniques and correct treatment of the complications will decrease the complications and improve future outcome.