前交通动脉瘤的介入栓塞治疗

Endovascular Embolization for Anterior Communicating Artery Aneurysms

目的总结前交通动脉瘤栓塞治疗的经验。方法 2008年1月-2011年8月,23例前交通动脉瘤患者均在全身麻醉下行动脉瘤内栓塞治疗。其中4例在导丝或导管保护动脉瘤颈情况下行栓塞治疗;1例术中导丝刺破动脉瘤,继续快速填塞至动脉瘤完全栓塞;1例栓塞后弹簧圈突入载瘤动脉,行A1-A2段支架后置入。结果 23例患者手术技术成功率100%。术后即刻造影,动脉瘤完全栓塞11例,>90%栓塞8例,<90%栓塞4例。支架后置入患者术后出现脑梗死,经治疗1个月后康复出院。所有患者临床随访6～24个月,未见再出血。16例患者行全脑血管数字减影血管成像复查,动脉瘤未见复发,其中3例>90%栓塞、2例<90%栓塞患者动脉瘤完全闭塞。结论弹簧圈栓塞治疗前交通动脉瘤是一种安全、有效的治疗方式。但其技术难度相对较大,需要细致操作。

Objective To summarize the treatment experiences of endovascular embolization for anterior communicating artery aneurysms.Methods Twenty-three patients with anterior communicating artery aneurysms were treated with endovascular embolization under general anesthesia between January 2008 and August 2011.Microcatheter-assisted or microwire-assisted technique was undertaken to keep patency of parent arteries in 4 patients.One patient suffered from aneurysm rupture during the procedure because of jumping of the microwire.One stent was post-planted in one case because of occlusion of the ipsilateral A2 segment.Results Interventional endovascular embolizations were performed successfully in 23 patients.Complete embolization was achieved in 11 cases,while subtotal in 8（90%） and partial in 4（90%） cases.The patient with stent planting suffered from cerebral infarction and recovered in one month.There was no re-hemorrhage during clinical follow-up of 6-24 months,and no recurrence in follow-up angiograms in 16 patients.Five aneurysms including 3 cases of primary subtotal and 2 cases of partial embolization occluded completely in the follow-up angiograms.Conclusion Endovascular embolization is a relatively safe and effective method for the management of anterior communicating artery aneurysm.