电解可脱性微弹簧圈血管内栓塞颅内动脉瘤的临床研究

Clinical study:endovascular embolization of intracranial aneurysm with coils

目的总结以电解可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的技术要点、并发症及其防治经验,并客观评价其治疗效果。方法对136例颅内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,应用电解可脱性弹簧圈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136个动脉瘤,132例痊愈,4例死亡,病死率2．9%。动脉瘤腔100%闭塞者123个,95%闭塞者8个,90%闭塞者5个。术中并发动脉瘤破裂3例,脑血管痉挛7例；术后2例弹簧圈末端逸出。3例复发者经二次补充栓塞而治愈。全组出现与栓塞技术相关的并发症13例。术后随访6～54个月均无再出血。结论对颅内动脉瘤采用电解可脱性弹簧圈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 technique and managements of complications in endovascular embolization on intracranial aneurysm with Guglielmi detachable coils（ GDC）, and to evaluate the effect of the treatment. Methods One hundred and thirty six cases with Aneurizym were treated using GDC to embolize the aneurismal sac via femoral artery approach. Results One hundred and thirty six aneurysms were cured. Of them 132 cases recovered clinically, 4 patients died. The mortality was 2.9%. The sac of 123 aneurysms were embolizied at 100%, 8 cases with 95% embolization, 5 with 90% embolization. 3 aneurysms reptured during the embolization, cerebral vasospasm happened in 7 cases. microcoil escaped in 2 case. Three recurring cases were cured after second GDC embolization. The technique-related complications occured in 13 cases. No re-bleeding occurred during the 6 to 54-month follow-up. Conclusion Endovascular embolization of intracranial aneurysm with coils is a safe and effective treatment for intracranial aneurysm. Advances in Techniques and treating the complications correctly would decrease the complications and improve future outcomes.