可脱性微弹簧圈血管内栓塞治疗颅内动脉瘤

Detachable coil embolization treatment of intracranial aneurysms

目的评价应用电解可脱性微弹簧圈(GDC)和机械可脱性微弹簧圈(MDC)血管内栓塞治疗颅内动脉瘤的治疗效果。材料与方法48例患者,经DSA检查显示脑动脉瘤55枚,其中后交通动脉瘤18枚,前交通动脉瘤15枚,大脑中动脉动脉瘤12枚,大脑前动脉动脉瘤5枚,其他部位动脉瘤5枚,静脉全麻及肝素化后,采用Seldinger穿刺技术,从股动脉插管,经微导管内途径将微弹簧圈送入动脉瘤内,诱发血栓形成并最终使动脉瘤闭塞,同时保持载瘤动脉通畅。结果栓塞55枚动脉瘤,技术成功率100%,41枚完全致密栓塞,14枚动脉瘤体栓塞90%～95%。48例患者,术中并发脑血管痉挛4例,无术中出血及死亡病例;术后1个月～3年内追踪45例,41例痊愈,3例残余瘤体、瘤颈扩大,1例再次发生蛛网膜下腔出血。结论GDC、MDC可有效地闭塞脑动脉瘤,是一种疗效可靠、微创、安全并且患者易接受的治疗方法。

Objective To evaluate the application of endovascular treatment with Guglielmi detachable coils（GDC） and mechanical detachable coils（MDC） in treatment of intracranial aneurysm.Materials and Methods 48 patients with 55 cerebral aneurysms were revealed by DSA examination,of which there were 18 aneurysms located in posterior communicating artery,15 in anterior communicating artery,12 in middle cerebral artery,5 in anterior cerebral artery,and 5 in other parts of cerebral artery.After intravenous anesthesia and heparin,Seldinger technique was used to puncture femoral artery.Coils were placed inside the aneurysm with micro-catheter to induce thrombosis and,ultimately,occlude the aneurysm with patent tumor feeding artery.Results 55 aneurysms were embolized,and the technical success rate was 100%.41 aneurysms were fully embolized,and 14 were embolized 90%～95%.Cerebral vasospasm was found in 4 cases,no bleeding and death cases.After 1 month to 3 years follow-up,41 cases recovered,residual tumor and neck extended was found in 3 cases,and re-subarachnoid hemorrhage occurred in 1 case.Conclusion It is effective,reliable,minimally invasive,safe and easy to embolize the cerebral aneurysm with GDC,MDC.