颅内破裂动脉瘤电解可脱性弹簧圈血管内早期栓塞治疗

Effect of early endovascular embolization using detachable coils for management of intracranial aneurysm rupture

目的 探讨早期电解可脱性弹簧圈血管内栓塞颅内破裂动脉瘤的临床疗效及应用价值。方法回顾性分析急诊用电解可脱性弹簧圈血管内栓塞治疗颅内破裂动脉瘤208例患者的临床资料。结果成功栓塞208例220个颅内动脉瘤，完全栓塞（〉95％）128个，大部分栓塞（80％～95％）80个，部分栓塞（〈79％）12个。并发动脉瘤破裂2例，1例痊愈，1例死亡；并发脑梗死5例，局部溶栓后遗留偏瘫和单瘫；3例弹簧圈末端遗留于动脉瘤外的载瘤动脉内，经抗凝治疗未发生并发症。12例复发再次栓塞后治愈。结论早期电解可脱性弹簧圈血管内栓塞治疗颅内破裂动脉瘤是一种较为安全、可靠、有效的治疗方法。

Objective To evaluate the therapeutic effect of endovascular embolization using Guglielmi detachable coils （GDCs） or electrolytically detachable coils （EDCs） for early treatment of ruptured intracranial aneurysms. Methods A total of 208 patients with 220 intracranial aneurysms were treated in the emergency setting using GDCs or EDCs after aneurysm rupture. Results All the 220 aneurysms were successfully embolized with the detachable coils. Complete embolization （〉95%） of the aneurysms was achieved in 128 of the 220 cases, and 80%-95% embolization in 80 cases, with the other 12 having an partial embolization less than 79%. Aneurysm rupture occurred in 2 patients during the embolization procedure, one of which was cured and the other died. Five patients sustained cerebral infarction, resulting in permanent hemiplegia or monoplegia after local thrombolytic therapy. In 3 cases, a small portion of the coil remained in the parent artery, but no complication occurred after anticoagulant therapy. Twelve patients experienced aneurysm recurrence, but was successfully managed with a second coil embolization procedure. Conclusion GDCs and EDCs can be safe, reliable and effective for early endovascular embolization of ruptured intracranial aneurysms.