颅内动脉瘤血管内栓塞治疗的临床效果

Endovascular embolization treatment of intracranial aneurysms

目的 探讨可脱性弹簧圈及可脱性球囊血管内栓塞治疗颅内动脉瘤的效果及技术要点。方法 对 194例颅内动脉瘤应用微导管技术 ,在数字减影血管造影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 ,6 9例 71个动脉瘤用电解式可脱性弹簧圈(GDC)栓塞。 40例巨大动脉瘤 37例用可脱性球囊闭塞载瘤动脉 ,2例用GDC ,1例用MDS闭塞载瘤动脉。结果 成功栓塞 194例 2 0 1个动脉瘤 ,191例痊愈 ,3例死亡。栓塞程度 :10 0 %栓塞 187个 (包括载瘤动脉闭塞者 ) ,95 %栓塞 8个 ,90 %栓塞 4个 ,80 %栓塞 1个。术中动脉瘤破裂 4例 ,并发脑梗死 4例 ,1例微弹簧末端逸出并顽固性脑血管痉挛。 2例复发者再给予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 ,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 detachable balloon and emphasize the mainpoint of embolic technique. Methods 194 patients underwent complete cerebral angiography using microcatheter under DSA imaging. 80 cases with 90 aneurysms were emboliced by MDS, 69 cases with 71 aneurysms were emboliced by GDC.37 of 40 giant aneurysms were emboliced by detachable balloon, 2 aneurysms by GDC, 1 by MDS. Results 194 patients with 201 aneurysms were cured successfully; 191 cases recovered clinically, 3 patients died. 187 aneurysms achieved 100% embolization, 8 with 95% embolization, 4 with 90% embolization, and 1 with 80% embolization. Four aneurysms reputured during the embolization, 4 patients had cerebral infarction, one patient died by hard treated cerebral vasospasm which was affected by microcoil escape. Two recurrent cases were cured by second GDC embolization. Conclusions The method of endovascular embolization to treat intracranial aneurysm is safe, reliable and effective. Those cases with giant aneurysms will have high recurrence in the future. Patients who suffer from SAH repeatedly may have great possibility of aneurysm rupture during embolization.