大脑中动脉分叉部动脉瘤的血管内栓塞治疗效果

Endovascular embolization in treatment of aneurysm in bifurcation of middle cerebral artery

目的总结大脑中动脉分叉部动脉瘤影像学特征、血管内栓塞治疗技巧及结果。方法采用微弹簧圈栓塞治疗大脑中动脉分叉部动脉瘤194例,对宽颈动脉瘤则采用瘤颈成形辅助技术,其中球囊辅助成形术17例,微导丝辅助成形技术19例,支架结合弹簧圈栓塞21例。结果栓塞程度:致密栓塞134例(69%),90%以上38例(20%),90%以下22例(11%)。术中出血9例(4.6%),死亡1例(0.5%)。结论电解可脱卸弹簧圈栓塞大脑中动脉分叉部动脉瘤具有微创、安全、效果可靠的优点。采用微导丝辅助瘤颈成形技术、瘤颈重塑形技术、血管内支架等方法,可以明显提高宽颈动脉瘤的致密栓塞率和减少脑梗死并发症发生。

Objective To summarize the radiographic characteristic and endovascular interventional technique in patients with aneurysm in bifurcation of middle cerebral artery. Methods A total of 194 patients of aneurysm in bifurcation of middle cerebral artery were embolized using coils, 17 with remodeling technique, 19 with microwire assisted coiling technique and 21 with stent. Results Total occlusion was achieved in 134 aneurysms （69%） , over 90% in aneurysms （20%） , less than 90% in 22 aneurysms （11%） , with 4 patients （4.6%） occurred bleeding and 1 patients （0.5%） died in the cohort. Conclusion The embolization of aneurysm in bifurcation of middle cerebral artery with coils is minimally invasive, safe, effective and reliable. Those techniques of microwire assisted coiling, remodelling and stent can improve the total occlusion rate and decrease cerebral infarction rate.