超早期血管内栓塞治疗颅内动脉瘤破裂

Endovascular Embolization Treatment of Ruptured Intracranial Aneurysms in Super-early Stage

目的:探讨颅内动脉瘤破裂超早期血管内介入治疗的临床效果。方法:23例不同部位颅内动脉瘤(26个)患者,术前Hunt-Hess分级:Ⅰ～Ⅱ级12例,Ⅲ级8例,Ⅳ级2例,Ⅴ级1例。在动脉瘤破裂48 h内气管内插管全麻下行电解式可脱性微弹簧圈(GDC)栓塞治疗。结果:术后随访6～24月,恢复良好者20例(86.95%);出现偏瘫和单纯运动性失语各1例(4.35%),后经综合治疗1个月后逐渐恢复;死亡1例(4.35%)(Hunt-HessⅤ级)。无再出血病例发生。结论:超早期电解式可脱性微弹簧圈栓塞治疗可避免动脉瘤再次破裂出血,减少脑血管痉挛,降低死亡率。

Objective To observe the efficacy of guglielmi detachable coil （GDC） used for embolism of ruptured aneurysm as emergent treatment in super-early stage. Methods Twenty-three cases suffered from intracranial aneurysms were treated by GDC within 48 hours. Preoperative Hunt-Hess grade： 12 cases were Ⅰ - Ⅱ, 8 cases were Ⅲ, 2 cases were Ivand 1 case was Ⅴ. Results After follow-up from 6 to 24 months after operation, 20 cases （86.95%） recovered excellently. Hemiplegia and anepia was found only in 1 case （4.35%） and Broca＇s aphasia 1 case （4.35%） after operation. But the two patients gradually recovered 1 month later. One case （4.35%） died because the Hunt-Hess was V grade. No rebleeding occurred. Conclusion The treatment for the patients from SAH Ⅰ- Ⅳ grade in super-early stage could avoid rebleeding from aneurysms, decrease the incidence of vasospasm and mortality.