血管内栓塞治疗颅内微小动脉瘤的临床研究

Clinical study on endovascular treatment of very small intracranial aneurysms

目的回顾性探讨和分析血管内栓塞治疗颅内微小动脉瘤(动脉瘤直径≤3.0mm)的临床可行性、难度及其适应证。方法总结分析55例经血管内栓塞治疗的颅内微小动脉瘤的相关临床因素,包括术前患者的临床一般状况、Hent-Hess分级、血管内栓塞治疗的并发症以及临床预后。结果 55例患者均进行血管内栓塞治疗,其中50例为破裂动脉瘤,5例为未破裂动脉瘤。血管内完全栓塞30例(54.55%),近全栓塞和部分栓塞25例(45.45%)。栓塞术中动脉瘤破裂出血4例(7.27%),术后再出血1例(1.81%),术后死亡1例(1.81%)。术后6个月随访显示,临床治愈47例(85.46%),轻度肢体活动功能障碍5例(9.09%),重度肢体活动障碍2例(3.64%),无复发及颅内再出血。结论血管内栓塞治疗颅内微小动脉瘤是有效、可行的;另外,结合患者的临床状况、预后选择最佳血管内治疗方案也很重要。

Objective To review and analyze the clinical feasibility and difficulty and indication of endovascular treatment in very small intracranial aneurysms（aneurismal diameter≤3.0mm）.Methods The all conditions of 55 consecutive endovascular treatment cases of very small intracranial aneurysms were summarized and analyzed,it included the patient＇s clinical general condition,the Hent-Hess grade,the complication of endovascular treatment and the clinical prognosis.Results 55 cases were embolized,and 50 ruptured aneurysms and 5 unruptured were included.30（54.55%） were completely embolized,and 25（45.45%） were partially embolized.Four（7.27%） were ruptured in the endovascular treatment,and one（1.81%） bled again and one（1.81%） died after treatment.All cases were followed-up 6 months after treatment： 47（85.46%） were clinical cured,five（9.09%） the mild impairment and two（3.64%） the serious impairment,but no recrudescence and bleeding again.Conclusion The endovascular treatment of very small intracranial aneurysms would be available and effective.Moreover,combining with patient＇s clinical condition and prognosis to select the best endovascular strategy is also very important.