单个弹簧圈栓塞颅内微小动脉瘤的单中心经验

Endovascular embolization with a single detachable coil for tiny intracranial aneurysms:a single-center experience

目的探讨单个弹簧圈栓塞颅内微小动脉瘤(最大径<3 mm)的可行性和疗效。方法 2001年1月至2011年1月对72例颅内微小动脉瘤患者的77个动脉瘤进行单个弹簧圈栓塞,其中动脉瘤破裂出血52例,多发性动脉瘤13例。用3D-DSA选择工作角度测量动脉瘤大小(前后径、上下径、宽颈、最大径和瘤颈)。随访脑血管造影3～88个月(平均24.8个月)。结果对所有77个微小动脉瘤成功实施了单个弹簧圈栓塞,其中10个采用球囊辅助弹簧圈栓塞,19个联合支架辅助弹簧圈栓塞。术中破裂出血7例,发生脑栓塞事件2例,术中弹簧圈移位2例。术后即刻造影示完全栓塞42个,次全栓塞30个,部分栓塞5个。除2例死亡外,所有病例进行了至少2次复查(术后3和12个月),其中再通5个,对3个进行了再次栓塞,延迟性弹簧圈移位2例。12个月后复查造影示完全栓塞61个,次全栓塞14个。结论单个弹簧圈栓塞颅内微小动脉瘤可行、安全并有效,联合支架辅助治疗可以降低其再通率。

Objective To discuss the feasibility and efficacy of endovascular embolization with a single detachable coil for the treatment of tiny intracranial aneurysms（the maximum diameter 3 mm）.Methods During the period from Jan.2001 to Jan.2011,endovascular embolization with a single detachable coil was performed in 72 patients carrying a total of 77 tiny intracranial aneurysms.Of the 72 patients,acute bleeding due to the rupture of the aneurysms was seen in 52 and multiple intracranial aneurysms in 13.Guided by the 3D DSA,the proper working project DSA images were selected to measure the diameter of the aneurysms,including anteroposterior diameter,longitudinal length,neck width and maximum diameter.All the patients were followed up for 3-88 months（mean 24.8 months） and follow-up examination with cerebral angiography was conducted.Results Endovascular embolization with a single detachable coil was successfully accomplished for all the 77 tiny intracranial aneurysms.Balloon-assisted coil embolization technique was used for 10 aneurysms,and stent-assisted technique was employed for 19 aneurysms.During the procedure,bleeding due to aneurysm rupture occurred in 7 patients,cerebral embolism events in 2 patients and coil migration in 2 patients.Cerebral angiography performed immediately after the treatment showed that complete occlusion of the aneurism was achieved in 42 aneurysms,subtotal occlusion in 30 aneurysms and incomplete occlusion in 5 aneurysms.Followed-up examination with DSA was conducted at 3 and 12 months after initial embolization in all patients except for two patients who died.Angiographic findings showed that 5 aneurysms were reopened and endovascular embolization had to be carried out for 3 aneurysms once more,and delayed coil migration occurred in two cases.Angiography performed at 12 months after last embolization showed that 61 aneurysms were completely occluded and 14 aneurysms were partially occluded.Conclusion For the treatment of tiny intracranial aneurysms endovascular embolization with a single detachable coil is clinically feasible,safe and effective,and this treatment can lower the reopen occurrence of the aneurysms if additional stent-assisted technique is simultaneously adopted.（J Intervent Radiol,2012,21： 7-13）