介入微弹簧圈栓塞术治疗颅内动脉瘤

Interventional microcoil embolization for the treatment of intracranial aneurysms

目的探讨介入微弹簧圈栓塞治疗颅内动脉瘤技术,评价临床疗效。方法采用介入方法微弹簧圈栓塞术,对114例119枚颅内动脉瘤进行栓塞治疗。临床表现为自发性蛛网膜下腔出血者107例。119枚动脉瘤中宽颈动脉瘤24枚,其中5枚采用支架辅助技术进行栓塞;2枚椎动脉梭形动脉瘤均进行了隔断绝栓塞术。结果119枚动脉瘤中118枚成功栓塞,其中完全致密闭塞72枚(60.5%),接近完全闭塞30枚(25.2%)、大部分闭塞13枚(10.9%),部分闭塞3枚(2.5%),1枚未能栓塞(0.8%)。6例前交通动脉瘤患者出现术中动脉瘤破裂,均继续栓塞后达到了基本致密的填塞,5例基本康复,1例留下残疾。术后1个月内死亡3例(2.5%),均为Hunt-Hess分级Ⅳ～Ⅴ级的患者,死于原先的严重出血或继发的严重脑血管痉挛。结论介入微弹簧圈栓塞治疗颅内动脉瘤是安全、有效的临床技术,积极、及时的栓塞治疗可有效防止动脉瘤再破裂。

Objective To discuss the techniques of interventional embozliation with microcoils for treatment of intracranial aneurysm and evaluate the clinical efficacy, Methods One hundred and nineteen intracranial aneurysms were embolized with microcoils in 114 patients among them 107 patients presented with subarqchnoid hemorrhage （SAH）. There were 24 wide-neck aneurysms in which 5 were embolized with stentassistant technique, Two fusiform vertebral artery aneurysms were embolized with also occlusion of the panent vessles. Results Intraarterial embolization was successfully performed in 118 of 119 aneurysms. The total occlusion achieved in 72 aneurysms（60.5%）, nearly total in 30（25.2%）, subtotal in 13（10,9%）, partial in 3 （2.5%）and failed in 1 （0,8%）, Intraoperative aneurysm rupture occurred in 6 patients with anterior communicating aneurysms. All of them were densely packed with luther coiling. Five patients recovered well and another patient had neurological deficit. Three patients （2.5%） died from original severe hemorrhage or cerebral vasospasm within 1 month after aneurysm embolization and all belonged to Ⅳ - Ⅴ grade according to Hunt-Hess classification. Conclusions Embolization of intracranial aneurysms with microcoils is safe and effective. Early coiling is active for prevention of re-rupture.