颅内血泡样动脉瘤的血管内治疗

Endovascular therapy for the intracranial blood blister-like aneurysms

目的分析颅内血泡样动脉瘤的临床特点、影像学特征,总结治疗经验。方法回顾性分析4例颈动脉血泡样动脉瘤及1例大脑前动脉疑似血泡样动脉瘤病人临床资料及随访结果,并进行相关文献复习。结果本组5例患者因蛛网膜下隙出血入院,DSA诊断为动脉瘤。应用单纯弹簧圈栓塞1例,术后出现再出血;首次采用支架辅助弹簧圈栓塞治疗4例,术后发生再出血1例,因动脉瘤再通予以再次辅助弹簧圈栓塞1例,其余2例患者病情好转出院,随访6-20个月,平均12.7个月。术后3个月改良Rankin评分为1分1例,2分1例,5分1例,6分2例。结论影像学检查可作为诊断血泡样动脉瘤的手段,瘤体短期内变化可辅助诊断;首次或再通时治疗采取支架辅助弹簧圈栓塞是一种可行方法。

Objective To analyze the clinical features and summarize the treatment experience of the intracranial blood blister-like aneurysms （BBAs）. Methods The medical records of four cases of carotid artery BBAs and one case of suspected middle cerebral ar- tery BBA were analyzed and the related literatures were reviewed. Results Five patients were hospitalized due to subarachnoid hem- orrhage, and diagnosed as BBAs by DSA. One was treated by coil embolization, and suffered from re-bleeding postoperatively. The other four patients carrying BBAs were treated by stent-assisted coil embolization, of which, one suffered from re-bleeding after the sur- gery, one received another stent-assisted coil embolization for the recanalized aneurysm, and the other two patients were discharged with a better condition. The alive patients were followed-up for a mean period of 12.7 months, ranged from 6 to 20 months. The modi- fied Rankin score of alive patients at 3 month was 1 score in one case, 2 scores in one case,5 scores in one case,and 6 scores in two cases died. Conclusion Angiography can be used to diagnose BBAs, and the changes of aneurysms size rapidly in a short time could be an assistant diagnosis way. Stent-assisted coil embolization is a feasible choice for the initial or follow-up rescue therapy.