血管内介入治疗颅内动脉瘤48例临床分析

Effect of endovascular treatment on intracranial aneurysms:a clinical analysis of 48 cases

目的探讨血管内介入治疗(Endovascular treatment,EVT)对颅内动脉瘤(Intracranial aneurysms,IAs)的疗效。方法 2010年1月～2012年3月巴中市中心医院行EVT治疗IAs患者48例共52个IAs,回顾性分析患者的临床资料并评定栓塞疗效。结果 52例IAs中,46例(88.5%)IAs为100%栓塞,5例(9.6%)为95%～99%栓塞,1例(1.9%)为<95%栓塞。45例中小型IAs中,41例(91.1%)IAs为100%栓塞,3例(6.7%)为95%～99%栓塞,1例(2.2%)为<95%栓塞;6例大型IAs中,4例(66.7%)为100%栓塞,2例(33.3%)为95%～99%栓塞;1例巨大型IA为100%栓塞。术中3例出现脑血管痉挛,1例出现IA破裂。EVT治疗后100%栓塞的46例IAs中,随访期内35例(76.1%)仍为100%栓塞,10例(21.7%)为95%～99%栓塞,1例(2.2%)为<95%栓塞;5例95%～99%栓塞的患者中,随访期内1例(20%)为100%栓塞,2例(40%)为95%～99%栓塞,2例(40%)为<95%栓塞。结论 EVT弹簧圈治疗IAs栓塞效果较好,特别是100%栓塞的患者;但术中有发生IAs破裂等严重并发症的可能,应尽量避免;术后随访很重要,对于栓塞效果不理想的患者可行再次手术。

Objective To investigate the effect of endovascular treatment （EVT） on intracranial aneurysms （IAs）. Methods From Jan 2010 to Mar 2012,the clinical datas of forty-eight patients with 53 IAs undergoing EVT in Bazhong central hospital were retrospectively analyzed to access the effect of EVT on IAs. Results Of all the 52 treated IAs, 100% occlusion was attained in 46（88.5%） IAs,95%-99% occlusion in 5 （9.6%） IAs,and 〈95% occlusion in 1 （1.9%） IA. Of 45 treated small or medium IAs, 100% occlusion was attained in 41 （91.1%） IAs, 95%-99% occlusion in 3 （6.7%） IAs, and 〈95% occlusion in 1 （2.2%） IA. In 6 large IAs and 1 giant IA,4 IAs（66.7%） and 1 （100%） were attained 100% occlusion respectively,the other 2 large IAs （33.3%） were 95%-99% occlusion. Cerebral vasospasm occurred in 3 case and IA rupture occurred in 1 case during procedure. Of 46 IAs with 100% occlusion after the first procedure,35（76.1%） remained 100% occlusion, 10（21.7%） remained 95%-99% occlusion,only 1（2.2%） had recanalized with 〈95% occlusion at the follow-up. Of 5 IAs with 95%-99% occlusion after the first procedure, 1 （20%） demonstrated 100% occlusion,2 （40%） remained 95%-99% occlusion,only 2 （40%） had recanalized with 〈95% occlusion at the follow-up. Conclusion The effect of endovascular treatment with coiling packing on IAs is satisfactory,especially for IAs which are attained to 100% occlusion. Since the existence of potential risk of serious com- plications such as IAs rupture, operators should performed carefully to avoid it. Following up after procedure is vital,re-operation should be performed if the first procedure was unsatisfactory.