颅内大型动脉瘤血管内治疗的长期随访

Long-term follow-up of endovascular treatment of large intracranial aneurysms

目的总结颅内大型动脉瘤血管内治疗的治疗策略、操作技巧和预后。方法回顾性分析血管内治疗的189例颅内大型和巨大动脉瘤病人的临床资料,其中闭塞载瘤动脉15例,单纯应用弹簧圈栓塞治疗27例,应用球囊辅助栓塞治疗48例,应用颅内自膨式辅助栓塞治疗99例。结果 189例病人共行手术247次,动脉瘤首次治疗致密栓塞133例,次全栓塞35例,部分栓塞21例。其中47例病人行分期栓塞治疗。术后7例出现血栓栓塞症状,死亡1例,偏瘫4例,其余病人恢复良好。随访16个月～5年,所有病人无再出血。结论血管内治疗颅内大型和巨大动脉瘤是一种安全有效的方法,合理运用辅助手段可有助于减少并发症、降低复发率。

Objective To summarize the therapeutic strategies,operation skills and prognosis of large cerebral aneurysms treated with endovascular technique.Methods Clinical data of 189 patients with large intracranial aneurysms were analyzed retrospectively,who were treated with endovascular treatment.Balloon parent artery occlusion was performed on 15 patients,coil embolization on 27,coil embolization assisted by balloon on 48 and coil embolization assisted by self-expanded stents on 99.Results All the patients received247 procedures in total.Complete embolization was achieved in 133 patients,incomplete embolization in 35 and partial embolization in21.And 47 patients received re-embolization.Complication thromboembolism occurred in 7 patients after surgery.One patient died,hemiparalysis occurred in 4 and the remaining recovered well.All the patients were followed up for 16 months to 5 years,and no rebleeding was found.Conclusions Endovascular treatment is a safe and effective method for large intracranial aneurysms.The reasonable usage of auxiliary techniques may help to reduce the complications and lower the recurrence rate.