颈内动脉前壁动脉瘤破裂后的血管内治疗

Endovascular intervention for ruptured anterior wall aneurysms of the internal carotid artery

目的总结颈内动脉前壁动脉瘤的影像学特征,评估其血管内治疗的临床疗效。方法回顾性分析12例颈内动脉前壁动脉瘤的病例资料。采用单纯弹簧圈栓塞3例,单纯支架植入3例,支架辅助弹簧圈栓塞4例,载瘤动脉闭塞2例。结果发生术中出血1例,术后再出血3例;出院时预后良好8例(66.7%),死亡4例(33.3%)。临床随访2～78个月,平均23个月;GOS5分7例,4分1例。结论血管内治疗是颈内动脉前壁动脉瘤的有效治疗方法。动脉瘤段载瘤动脉闭塞是治疗此类动脉瘤最确实的方法,但对于球囊闭塞试验阳性,或动脉瘤颈对侧壁有重要穿支的病人,可考虑行支架辅助弹簧圈栓塞术。

Objective To summarize the imaging features of anterior wall aneurysms of internal carotid artery （AWAICA） and evaluate the clinical outcomes of endovascular treatment. Methods Clinical experience with endovascular treatment of AWAICAs in 12 patients was analyzed retrospectively. Three patients were treated with coil embolization, 3 with stent alone, 4 with stent-assisted coil embolization, and 2 with the parent artery occlusion. Results Intraoperative bleeding occurred in one patient, and postoperative bleeding in 3. Eight patients were shown to have favorable prognoses at discharge （66.7%）, and 4 patients died （33.3%）. The mean follow-up period was 23 months （ranged from 3 to 78 months）, 7 patients got GOS score of 5 and 1 got 4. Conclusion Endovascular treatment is an effective for AWAICA, and parent artery occlusion is the most definite treatment, however, stent-assisted coil embolization should be given to the patients who have positive balloon occlusion test or important perforating branches on the apposite wall of the aneurysms.