血管内治疗颅内微小动脉瘤

Endovascular Treatment of very small intracranial aneurysms(report of 138 cases)

目的探讨血管内治疗颅内微小动脉瘤(直径≤3.0mm)的技巧及其临床效果。方法回顾性分析血管内治疗的133例颅内微小动脉瘤患者的临床资料。共138个动脉瘤,其中57个动脉瘤行单纯弹簧圈栓塞治疗;81个宽颈动脉瘤中,74个使用支架辅助弹簧圈栓塞治疗,7个以支架覆盖瘤颈(1例为双支架套叠置放)。结果成功进行弹簧圈栓塞治疗动脉瘤131个,成功率为94.93%;弹簧圈和动脉瘤平均体积分别为(6.77±5.08)mm3和(9.71±4.43)mm3,平均弹簧圈栓塞容积比为(31.96±14.02)%。按Raymond分级方法,术后即刻造影示动脉瘤完全栓塞119个(86.23%),瘤颈残留12个(8.70%),瘤腔残留7个(5.07%)。术中发生并发症16例(11.59%),其中出血性卒中11例,缺血性卒中5例。术后30d根据GOS评分评定预后,1级,4例;2级,13例;3级,11例;4级,42例;5级,63例。56例患者术后随访6～24个月,平均7.11月,无动脉瘤再次破裂出血。结论颅内微小动脉瘤单纯使用弹簧圈或结合颅内支架栓塞是较好的治疗方法。

Objective To explore the technique of endovascular embolization of very small aneurysms and its clinical effect on them. Methods The clinical data of 133 patients with 138 very small intracranial aneurysms （the diameter ≤3 mm）, of which 131 were embolized with coils or stent-assisted coils and 7 received the covering of aneurysmal necks with stents only, were analyzed retrospectively. Results The average volume of 131 intracranial aneurysms embolized with coils or stent-assisted coils was （9.71±4.43） mm3. The average volume of the coils was （6.77±5.08）mm3. The volumetric percentage of occlusion was （31.96±14.02）%. Of 138 aneurysms, 119 （86.23%） was totally embolizated, 12（8.70%） had residual aneurismal necks and 7 （5.07%） had residual aneurysmal cavities. Complications occurred in 16 patients （11.59%）, of whom, 5 had cerebral ischemia and 11 cerebral hemorrhage. Of 133 patients, 4 belonged in GOS grade Ⅰ, 13 in grade Ⅱ, 11 in grade Ⅲ, 46 in grade Ⅳ, 64 in grade Ⅴ 30 days after the operation. No rebleeding occurred in 56 patients followed up from 6 to 24 months. Conclusion The endovascular embolization of with coil only or stents combined with coils is a safe and effective method to treat the very small intracranial aneurysms.