大脑中动脉M1段动脉瘤的血管内治疗

Endovascular treatment of middle cerebral artery Ml segment aneurysms

目的探讨血管内治疗大脑中动脉M1段动脉瘤的可行性、安全性和有效性。方法回顾性分析第二军医大学长海医院神经外科2008年8月—2009年12月采用血管内治疗的15例大脑中动脉M1段动脉瘤患者的临床资料。采用全身麻醉和Seldinger技术,经股动脉穿刺,单纯置入支架、弹簧圈或支架辅助弹簧圈治疗。结果①采用血管内栓塞治疗的所有动脉瘤均获成功,其中单纯弹簧圈栓塞术治疗5例,采用单纯支架置入术治疗3例,支架结合弹簧圈栓塞术治疗7例。②术后即刻造影显示,致密栓塞5例,瘤颈显影4例,瘤体显影3例;单纯支架置人即刻造影,显示瘤内对比剂明显滞留3例,术中未发生动脉瘤破裂。③术后发生手术相关并发症1例(左侧基底核区梗死,右侧肢体肌力为0级);出院时改良Rankin评分4分,半年后随访改良Rankin评分2分。7例患者接受DSA复查(3～8个月,平均6.1个月),其中2例发生动脉瘤再通,给予再次栓塞;15例患者临床随访3～20个月(平均7.7个月),无新发神经系统症状,未发生动脉瘤再次破裂出血。结论血管内栓塞治疗大脑中动脉M1段动脉瘤技术上是可行的,安全性高,其长期疗效有待于进一步随访。

Objective To evaluate the feasibility, safety and efficacy of endovascular treatment of middle cerebral artery M1 segment aneurysms. Methods The clinical data of 15 patients with 20 middle cerebral artery M1 segment aneurysms treated endovascularly in Changhai Hospital, the Second Military Medical University from August 2008 to December 2009 were analyzed retrospectively. General anesthesia and Seldinger technique were used via femoral artery, stenting, coiling or stents in combination with coils were used. Results （1）All the aneurysms were treated successfully using endovascular treatment, include coiling for 5 cases, stenting for 3 case, and stenting in combination with coiling for 7 cases. （2）The aneurysms were densely packed in 5 cases immediately after surgery, aneurysm neck unpacked in 4 cases, and aneurysm body unpacked in 3 cases. The contrast agent in aneurysm of 3 cases were obviously detained immediately after stenting alone. No intraoperative aneurysm rupture was observed. （3）The procedure-related complication was occurred in 1 case （left basal ganglia infarction and paralysis of right limbs）. The modified Rankin Scale （mRS） score was 4 at discharge, and improved to 2 after 6-month follow-up. Seven patients received DSA reexamination （3 - 8 months after the procedure ）, 2 of them had recanalization of the aneurysms and were densely packed again with coils; 15 patients were followed up for 3 to 20 months （mean 7. 7 months ）, no newly developed neurological symptoms and aneurysm rerupture occurred. Conclusion Endovascular embolization of middle cerebral artery M1 segment aneurysms is technically leasible and safe. However, its long-term efficacy needs to be further observed.