破裂性大脑中动脉瘤的临床特点及血管内栓塞治疗

Clinical features of ruptured middle cerebral artery aneurysm and endovascular embolization therapy

目的总结破裂性大脑中动脉瘤的临床特点以及血管内栓塞治疗的疗效与技术要点。方法对32例破裂性大脑中动脉瘤患者用电解可脱性弹簧圈（GDC）进行动脉瘤囊内栓塞；术后早期处理出血。结果32个动脉瘤中27个瘤腔100％闭塞，3个95％闭塞，2个90％闭塞。术后30例临床痊愈，2例死亡，死亡率6．3％。术中并发脑血管痉挛4例；术后并发脑梗塞1例。1例复发者经二次补充GDC栓塞治愈。全组出现与栓塞技术相关的并发症4例。术后随访3～72个月均无再出血。结论对破裂性大脑中动脉瘤采用GDC进行血管内囊内栓塞疗效可靠；早期栓塞及有效的术后处理是提高破裂性大脑中动脉瘤治愈率的重要方法。

Objective To summarize clinical features of middle cerebral artery aneurysms and the techniques and treatment effect of endovascular embolization with Guglielmi detachable coils （GDC）. Methods A total of 32 cases with middle cerebral artery aneurysms were treated with GDC to embolize the aneurismal sac via femoral artery approach. Early intervention of hemorrhage was performed post-operation. Results All 32 patients were cured, in which 30 cases recovered clinically and 2 patients died. The mortality was 6.3%. The 100% embolization were achieved in 27 sacs of aneurysms, 95% embolization in 3, and 90% embolization in 2. Aneurysms had not ruptured during the embolization. Cerebral vasospasm happened in 4 cases and cerebral infarct in 1 case. One case of recurrence was cured by second GDC embolization. The technique-related complications presented in 4 cases. No re-bleeding occurred during the follow-up of 3 to 72 months. Conclusion The endovascular embolization is a safe and effective treatment for the middle cerebral artery aneurysms. Early embolization of aneurysms and efficient treatment in post-operation are the important methods to improve the curative rate.