可脱性弹簧圈血管内栓塞颅内动脉瘤(附 1 2 6例分析 )

Endovascular embolization of intracranial aneurysms with detachable coil (126 cases analysis).

目的 探讨可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的效果及技术要点。方法 对 1 2 6例颅内动脉瘤应用微导管技术 ,在数字减影血管造影 (DSA)监视下行血管内栓塞治疗 ,其中 85例 90个动脉瘤用机械式可脱性弹簧圈 (MDS)栓塞 ,41例 42个动脉瘤用电解式可脱性弹簧圈 (GDC)栓塞。结果 成功栓塞 1 2 6例 1 3 2个动脉瘤 ,1 2 3例痊愈 ,3例死亡。1 0 0 %栓塞 1 2 4个 ,95%栓塞 6个 ,90 %栓塞 2个。并发动脉瘤破裂 4例 ,并发脑梗死 2例 ,其中 1例痊愈 ,1例死亡 ;1例微弹簧末端逸出并顽固性脑血管痉挛致死亡。 2例复发者再予GDC栓塞而治愈。结论 血管内栓塞治疗颅内动脉瘤是一种比较安全、可靠、有效的治疗手段 ,但动脉硬化明显 ,导管到位困难者及术前呼吸、循环功能衰竭者不宜行血管内治疗。动脉瘤较大者 ,术后复发率高 ;术前反复蛛网膜下腔出血者 ,术中动脉瘤破裂的可能性较大。

Objective To evaluate the effect of endovascular embolization of intracranial aneurysms with detachable coil and emphasize the mainpoint of the embolic technique.Methods 126 patients underwent complete cerebral angiography by using microcatheter under the DSA imaging. 80 cases with 90 aneurysms were embolized by MDS, 41 cases with 42 aneurysms were embolized by GDC.Results 126 patients with 132 aneurysms were cured. 123 cases recovered clinically, 3 patients died. 124 aneurysms were achieved 100% embolization, 6 with 95% embolization, 2 with 90% embolization. Four aneurysms reputured during the embolization, 2 patients had cerebral infarction, one cured, one died. One patient died by hard treated cerebral vasospasm which was affected by microcoil escaped. Two recurring cases cured by second GDC embolication. Conclusions The method of endovascular emdolication to treat the intracranial aneurysm is safe, reliable and effective, but those patients who had atherosclerosis and cardiopulmonary failure before the operation should not be treated by endovascular emdolization. Those cases with huge aneurysms will had high recurrence in future. The patients who had suffered SAH repeatedly had the great possibility of the aneurysm ruptured during the embolization