电解式可脱弹簧圈治疗颅内动脉瘤

ENDOVASCULAR TREATMENT FOR INTRACRANIAL ANEURYSMS WITH GUGLIELMI DETACHABLE COILS

目的 :总结电解式可脱弹簧圈 (GDC)栓塞治疗颅内动脉瘤的经验和体会。方法 :1999年 5月～ 2 0 0 0年10月采用GDC栓塞治疗 41例 43个颅内动脉瘤。男 2 8例 ,女 13例 :年龄 2 2～ 6 8岁 ,平均 47.5岁。蛛网膜下腔出血 38例 ,头痛 3例 ,术前Hunt和Hess分级 ,37例为Ⅰ、Ⅱ级 ,4例Ⅲ级。结果 :栓塞治疗的 43个动脉瘤 ,完全栓塞 (10 0 % ) 35个 ,次全栓塞 (90 %～ 99% ) 4个 ,不全栓塞 (<90 % ) 4个。术中血栓形成 2例 ,经溶栓和抗凝治疗 1例恢复正常 ,1例遗留轻偏瘫 ,微导丝刺破动脉瘤壁 1例 ,致密填塞弹簧圈后治愈 ,弹簧圈部分脱入载瘤动脉内 1例 ,无神经功能障碍。无死亡。结论 :GDC栓塞治疗颅内动脉瘤安全、有效 ,但多种因素影响治疗效果。

Objective:To assess the effect of embolizing intracranial aneurysms.Methods:From May 1999 to October 2000,41 patients with 43 intracranial aneurysms were treated with GDC in our department including 28 males and 13 females,aged from 22 to 68 years,mean 47.5 years.38 patients presented with subarachnoid hemorrhage,and 3 with headache.Before the procedure,37 patients had Hunt and Hess grade Ⅰ～Ⅱ and 4 had grade Ⅲ.Results:Of 43 aneurysms who underwent GDC embolization,a complete occlusion (100%) was achieved in 35 aneurysms,subtotal occlusion (90～99%)in 4,and incomplete occlusion (<90%) in 4.Of 2 patients who suffered thrombosis during the procedure,1 recovered and 1 presented with hemiparesis after urokinase perfusion and anticoagulation.One was cured,who experienced aneurysmal wall perforation due to microguidewire,after densely packing coils.Partial prolapse of the coil into the parent artery was happened in 1 patient,but the patient presented with no neurological deficit.No death occurred in our group.Conclusions:Endovascular treatment of intracranial aneurysms with GDC is a safe and effective alternative.May factors may influence the effect of the treatment.