Hunt-Hess高分级颅内动脉瘤的血管内栓塞治疗

Endovascular embolization treatment for Hunt-Hess poor-grade intracranial aneurysms

目的 探讨Hunt-Hess高分级颅内动脉瘤血管内栓塞治疗的临床疗效及应用价值.方法 2001年5月至2010年2月采用血管内栓塞治疗87例颅内动脉瘤,Hunt-Hess Ⅳ级77例,Ⅴ级10例.以格拉斯哥预后分级（GOS）评估预后.结果 随访3个月至9年.GOS结果：Ⅰ级25例,Ⅱ级5例,Ⅲ级9例,Ⅳ级12例,Ⅴ级36例,预后良好率55.17%（48/87）,病死率28.74%（25/87）.47例早期（发病后3 d内）治疗患者预后良好率61.70%（29/47）,病死率25.53%（12/47）;40例中晚期（发病后3d及以后）治疗患者预后良好率47.50%（19/40）,病死率32.50%（13/40）.早期治疗患者和中晚期治疗患者预后良好率和病死率比较差异均无统计学意义（P＞0.05）.87例患者均能成功栓塞治疗,技术并发症8例.脑血管造影发现血管痉挛1O例.结论 血管内栓塞是治疗Hunt-Hess高分级颅内动脉瘤有效方法,早期治疗可行、有效,能通过减少动脉瘤再破裂出血和防治血管痉挛提高预后.

Objective To explore the clinical therapeutic efficacy and value of endovascular embolization treatment for Hunt-Hess poor-grade intracranial aneurysms. Methods Eighty-seven patients with Hunt-Hess grade Ⅳ - Ⅴ intracranial aneurysrns were treated with endovascular embolization from May 2001 to February 2010,77 patients were grade Ⅳ and 10 patients were grade Ⅴ. Outcomes were assessed by using the Glasgow outcome scale （GOS）. Results Follow-up time was from 3 months to 9 years. The therapeutic efficacy was as following according to GOS： 25 patients were grade Ⅰ , 5 patients were grade Ⅱ , 9 patients were grade Ⅲ , 12 patients were grade Ⅳ ,and 36 patients were grade Ⅴ. There were 55.17%（48/87） favorable outcome rate and 28.74% （25/87） mortality rate in all patients. There were 61.70%（29/47） favorable outcome rate and 25.53%（12/47） mortality rate in early stage treatment patients （diseased within 3 d）, otherwise there were 47.50% （19/40） favorable outcome rate and 32.50%（13/40） mortality rate in medium and late stage treatment patients （diseased 3 d or later）. There were no statistically significance in favorable outcome rate and mortality rate between them （P 〉 0.05）. All the patients were embolized successfully ,technical complications occurred in 8 patients, 10 patients were found angiographic evidence of vasospasm. Conclusions Endovascular embolization is an effective method for treating Hunt-Hess poorgrade intracranial aneurysms. Early stage treatment is a feasible option because it can improve prognosis by reducing rebleeding and vasospasm.