后交通动脉动脉瘤的临床特点及血管内栓塞治疗(附318例报告)

Clinical characteristics and endovascular embolization of posterior communicating artery aneurysms(report of 318 cases)

目的总结后交通动脉动脉瘤的临床特点及血管内栓塞治疗的效果。方法对318例后交通动脉动脉瘤患者均行血管内治疗。结果致密填塞291例,仅瘤颈残留16例,大部填塞11例。按GOS评定预后,恢复良好260例,中残27例;重残20例,植物生存3例;死亡8例。术中动脉瘤破裂12例,死亡3例。术中支架内血栓形成3例,死亡1例。103例患者出院后随访3～72个月,89例恢复正常工作,8例生活自理,6例生活不能自理。13例并发交通性脑积水,经脑室-腹腔分流术治愈。32例复查DSA,3例动脉瘤复发,经再次血管内栓塞后治愈。结论血管内栓塞可有效治疗后交通动脉动脉瘤。

Objective To explore clinical characteristics of the posterior communicating artery （PCoA） aneurysms and the curative effect of endovascular embolization on them. Methods The clinical data of 318 patients with PCoA aneurysms, whom underwent endovascular treatment, were analyzed retrospectively. The preoperative disease conditions in 12 patients belonged in Hunt-Hess grade 0, ones in 85 did in grade I , ones in 93 did in grade II, ones in 107 did in grade III, ones in 19 did in grade IV and ones in 2 did in grade V. Results Of the 318 aneurysms, 291 were tightly occluded, 16 had only the aneurysmal neck remnants and 11 were incompletely occluded. Of the 318 patients, 260 were recovered well, 27 moderately disabled, 20 severely disabled, 3 vegetatively survived and 8 died according to GOS after the treatment. Three patients died in 12 patients suffered from the aneurismal rupture during the endovaseular embolization with coils. One patient died in 3 patients in whom intrastent thrombosis occurred intraoperatively. Of 103 patients followed up from 3 to 72 months, 89 returned to normal work, 8 could only take care of themselves, and 6 could not take care of themselves. Thirteen patients suffering from hydrocephalus after the embolization were cured by the ventriculo-peritoneal shunt. Three patients suffering from the recurrent arleurysms during the following up were cured by the re-embolization. Conclusion The endovaseular embolization is an effective method to treat PCoA aneurysms.