颅内动脉瘤破裂中期的血管内治疗

Endovascular treatment of ruptured intracranial aneurysms in medium-term

目的探讨颅内动脉瘤破裂中期（4-10d）血管内栓塞治疗的安全性、技术要点及疗效。方法根据在DSA影像上有无脑血管痉挛（CVS）将全组48例患者分为两组：A组26例为有CVS者，B组22例为无CVS者。全组均在蛛网膜下腔出血（SAH）后4-10d采用可脱性微弹簧圈对破裂性颅内动脉瘤行囊内栓塞。患者均在治疗后3个月时行Glasgow预后评分（GOS），治疗结果经，检验。结果全组动脉瘤腔100％闭塞42例，95％闭塞者4例，90％闭塞者2例；其中100％闭塞的患者中A组22例，B组20例，两组完全栓塞率比较差别无统计学意义（X^2=0．43，P〉0．05）。术中出现与栓塞技术相关的并发症3例。A组GOS：Ⅰ级10例，Ⅱ级5例，Ⅲ级7例，Ⅳ级1例，V级3例；B组GOS：Ⅰ级17例，Ⅱ级3例，Ⅲ级1例，Ⅳ级0例，V级1例。全组死亡率8．3％。术后随访3-58个月均无再出血及动脉瘤复发。结论动脉瘤破裂后在中期（4-10d）并不是都伴有CVS；在该期对破裂性颅内动脉瘤采用可脱性弹簧圈进行血管内囊内栓塞安全可行、疗效可靠。

Objective To investigate the security, main technical points and curative effect of endovascular embolization in medium-term of ruptured intracranial aneurysms. Method According to digital subtraction arteriography, all of the 48 cases were divided into two groups： A was 26 cases with cerebral vasospasm and B 22 cases without cerebral vasospasm. All cases with ruptured intracranial aneurysms were embolized 4-10 days after subarachnoid hemorrhage with detachable micro-coils. Patients were all scored with Glasgow Outcome Scale 3 months after surgery. The therapeutic result was tested byX^2. Results Of the 48 ruptured intracranial aneurysms, 42 cases were 100 % occluded, 4 cases 95 % occluded, and 2 cases 90 % occluded. The number of complete embolization cases in group A were 22 and in group B 20. There was not significant difference between the two groups in complete embolism rate（X^2=0.43,P〉0.05 ）o During the operation, 3 cases happened technique-related complications. According to the Glasgow prognosis score, the therapeutic efficacy in group A was that： l0 patients were in grade Ⅰ , 5 in grade Ⅱ , 7 in grade Ⅲ, 1 in grade Ⅳ, and 3 in grade V ; and in group B： 17 patients were in grade Ⅰ , 3 in grade Ⅱ , 1 in grade Ⅲ, 0 in grade IV, and 1 in grade V. The mortality rate in all cases was 8.3%. None was rebreeding and recidivism follow-up 3 to 58 months after operation. Conclusions Not all ruptured intracranial aneurysms have cerebral vasospasm in medium-term （4-10 days after SAH ）. It is safe and reliable to embolize the ruptured intracranial aneurysm with detachable micro-coils in this period.