弹簧圈栓塞治疗脑动脉瘤:材料、安全性效果

Spring ring embolization for cerebral aneurysm:material and security outcomes

目的:汇总分析弹簧圈栓塞治疗脑动脉瘤的临床效果。方法:由作者应用计算机检索1990/2008PubMed数据(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关弹簧圈栓塞治疗脑动脉瘤的研究,英文检索词为"aneurysm of brain,spring ring interventional therapy,embolism",中文检索词为"脑动脉瘤,栓塞,弹簧圈,血管内治疗"。排除重复性研究。计算机初检得到54篇文献,根据纳入标准保留14篇进一步归纳总结。结果:纳入的14篇文献显示,栓塞前需行全脑血管造影了解颅内循环情况,并测量动脉瘤颈、瘤体大小。微导管到位后,一般不行超选择造影,以避免动脉瘤破裂。选择合适的导管、导丝至关重要。要选择与动脉瘤大小相当直径的弹簧圈,放置时要尽可能使其沿着动脉瘤的壁盘旋缠绕。形成初步"筐架",以利于其他弹簧圈在"筐架"中盘旋。尽量做到弹簧圈在动脉瘤内致密填塞,以免动脉瘤复发。最后一个弹簧圈不宜过长,避免难以完全填入。弹簧圈在解脱前均应造影证实其在动脉瘤内,确保载瘤动脉通畅。操作过程要轻柔,导丝、导管前进一段路程后要注意轻轻回撤少许,以卸掉因所过弯曲较多而产生的张力,防止产生"疏忽前跃"现象,导致刺破动脉瘤。结论:弹簧圈血管内栓塞是治疗脑动脉瘤较理想的方法,具有微创、安全可靠、效果确切的特点。

OBJECTIVE：To summarize and analyze the clinical outcomes of coil embolization for treating cerebral aneurismal.METHODS：Authors retrieved PubMed Database （http：//www.ncbi.nlm.nih.gov/PubMed） and Wanfang Database （http：//www.wanfangdata.com.cn） by using a computer for articles concerning coil embolization for treating cerebral aneurismal published from 1990 to 2008.The Key words were ＂aneurysm of brain,spring ring interventional therapy,embolism＂ in English,and ＂cerebral aneurysm,embolism,circlip ring,endovascular treatment＂ in Chinese.Duplicated studies were excluded.A total of 54 articles were obtained by primary screening.According to inclusion criteria,14 articles were further summarized.RESULTS：The included 14 articles exhibited that aortocranial angiography was conducted before embolism to understand intracalvarium circulation and to measure aneurysm neck and size.Following microtubular in position,superselective angiography was not performed to avoid aneurysm rupture.It was important to select suitable catheter and guide wire.Spring ring with the same diameter as aneurysm size was selected.When placed it,it should be twisted around the wall of aneurysm to form a primary ＂frame＂,which was beneficial for spiral of other spring rings in the ＂frame＂.Try to make spring ring densely plugged in aneurysm to avoid aneurysm relapse.The last spring ring should not be too long so as to avoid difficulty in complete filling-in.Before disengage,the spring ring should undergo visualization to verify that it was in the aneurysm to ensure the patency of parent artery.The operation should be light and soft.Following proceeding a path,the guide wire and catheter should be slightly withdrawn a part to unload the tension induced by bending,resulting in avoiding ＂negligence-induced leaping forwards＂ that may pierce the aneurysm.CONCLUSION：Spring ring endovascular embolization is an ideal method to treat cerebral aneurysm,with characteristics of microinvasion,security,reliability and definite outcomes.