破裂颅内微小动脉瘤介入栓塞技术探讨

Endovascular treatment of ruptured intracranial very small aneurysms

目的评估介入栓塞破裂颅内微小动脉瘤的疗效和安全,探讨介入栓塞此类动脉瘤的技术要点。方法回顾性分析2007-01-2010-11郑州大学第一附属医院22例微小动脉瘤破裂所致的蛛网膜下腔出血患者的临床、影像学结果和术中操作。所有患者均全麻下采用弹簧圈栓塞治疗（其中13例采用单纯弹簧栓塞,7例支架辅助,2例球囊辅助）。结果 22个动脉瘤中,致密栓塞17例,瘤颈残留1例,瘤腔残留4例,未出现弹簧圈移位和载瘤动脉血栓栓塞事件,术中出现动脉瘤破裂出血2例,术后一过性轻偏瘫1例,死亡1例。结论介入栓塞破裂颅内微小动脉瘤效果可靠;规范且熟练的操作,选择适合的手术方式和介入材料的合适是微小动脉瘤治疗成败的关键。

Objective To explore the technique of endovascular therapy of ruptured intracranial very small aneurysms,and evaluate the feasibility and safety of endovascular treatment of such aneurysms.Methods Twenty-two intracranial very small aneurysms in 22 patients with subarachnoid hemorrhage treated by endovascular therapy were reviewed retrospectively in clinical,imaging,interventional and follow-up data.All aneurysms were embolized with coils,of which 7 with stent assistance and 2 by balloon remodeling technique.Results Among 22 coiling aneurysms,complete occlusion was achieved in 17 aneurysms,neck remnant occurred in 1 patient and aneurysm remnant occurred in 4 patients.Two aneurysms ruptured during coiling and one patient died due to it.One patient had transient hemiparesis.All patients were followed up for 3～36 months and no recurrent hemorrhage occurred.Conclusion Endovascular treatment of ruptured intracranial very small aneurysms seems to be technically feasible,relatively safe and practically effective.Appropriate selection of interventional materials and use of sophisticated techniques allow a good outcome.