血管内栓塞治疗破裂前交通宽颈动脉瘤的技术分析

Technical analysis of endovascular embolization for wide-necked aneurysms of ruptured anterior communicating arteries

目的：探讨血管内栓塞治疗破裂前交通宽颈动脉瘤的安全性、疗效及技术要点。方法：回顾性分析血管内栓塞治疗35例破裂前交通宽颈动脉瘤的临床、DSA及介入治疗、随访资料。结果：术后即刻造影栓塞100％29例（82．9％）。90％5例（14．3％），80％1例（2．8％）。术中发生同侧大脑前动脉闭塞1例，溶栓后血管通畅；动脉瘤破裂出血1例；术后大脑前动脉梗死1例。临床随访6-60个月，无动脉瘤再次破裂出血：21例DSA随访6～60个月。其中2例复发，未予治疗。结论：血管内栓塞治疗破裂前交通宽颈动脉瘤难度较大，但安全、有效。灵活选择各种栓塞技术，设计最适宜的栓塞治疗计划，是提高前交通破裂宽颈动脉瘤治疗效果的关键。

Objective To investigate the safety, efficacy and key points of technology of endovascular embolization for ruptured wide-necked aneurysms of anterior communicating arteries. Methods The clinical, DSA imaging, interventional treatment and follow-up data of 35 patients with ruptured wide-neck aneurysms of anterior communicating arteries were analyzed retrospectively. Results Immediate postoperative angiography of the 35 patients found 100% occlusion were achieved in 29 （82.9%）, 90% occlusion were achieved in 5 （14.3%）, and 80% occlusion was achieved in 1 （2.8%）. One patient had occlusion in ipsilateral anterior cerebral artery, whose blood vessel was patent after thrombosis. One patient had intraoperative aneurysm rupture. One patient had cerebral infaraction of anterior cerebral artery after the operation. Clinical follow-up was made from 6 to 60 months, and no aneurysms ruptured was found. 21 patients were followed up for 6 to 60 months with DSA. Two of them experienced recurrence, and they were not treated with supplementary packing. Conclusion Endovascular embolization for ruptured wide-necked aneurysms of anterior communicating arteries is more difficult, but it is safe and effective. Flexible choosing of various kinds of embolism technique and designing the most optimal embolism treatment plan are the keys to the improvement of embolization effect.