颅内动脉瘤夹闭术后残留的血管内介入治疗

Endovascular coiling of aneurysmal remnants after clipping of intracranial aneurysms

目的探讨颅内动脉瘤夹闭术后残留病灶的特点及血管内介入治疗方法。方法 5例行手术夹闭的颅内动脉瘤患者经脑血管造影复查发现瘤体残留,均在全麻下行弹簧圈栓塞术,其中2例采用支架辅助。以"residual aneurysm"、"incomplete clipping"及"endovascular coiling"为关键词检索Pubmed网络数据库并筛选相关文献。结果 4例残留动脉瘤致密栓塞(1例采用支架辅助),另一例采用支架辅助弹簧圈栓塞者瘤颈少量残留,6个月后随访时残留部分消失。检索得到相关文献10篇。结论对于夹闭术后残留的动脉瘤,再次手术夹闭的难度及风险较大;血管内介入治疗是处理此类病灶的一种安全、有效的方式。

Objective To discuss the characteristics and endovascular coiling of aneurysmal remnants after clipping of intracranial aneurysms. Methods Five cases, who experienced clipping surgeries previously, were diagnosed angiographically as aneurysmal remnants. The lesions were coiled under general anesthesia, and two of them were assisted by stents. The relevant literatures were retrieved and filtered with the key words as ＂residual aneurysm＂ , ＂incomplete clipping＂ and ＂endovascular coiling＂ from the Pubmed database via internet. Results The total occlusion of lesions was achieved in four cases, with stenting in one case. The partial remnant of aneurysmal neck after stent assisted coiling occurred in one case and disappeared angiographically in six months＇ follow-up. Ten relevant literatures were gained from the Pubmed database. Conclusions It is more difficult and dangerous to re-clip the aneurysmat remnant after previous clipping. Endovascular coiling is an effective and safe therapy for the treatment of such lesions.