颅内破裂微小动脉瘤介入栓塞治疗技术探讨

Endovascular embolization treatment of ruptured intracranial tiny aneurysms: technical discussion

目的探讨介入栓塞术治疗颅内破裂微小动脉瘤技术要点，并评估此技术的疗效和安全性。方法回顾性分析2008年1月至2013年6月采用介入栓塞术治疗的30例共36枚颅内破裂微小动脉瘤的临床、影像学、操作技术和随访资料，其中24枚动脉瘤接受单纯弹簧圈填塞，5枚接受球囊辅助弹簧圈栓塞，7枚接受支架辅助弹簧圈栓塞。结果术中出现动脉瘤破裂出血2例，死亡1例。术后即刻造影显示，36枚颅内微小动脉瘤中22枚（61．1％）达到致密填塞，14枚（38．9％）非致密填塞。25枚动脉瘤获得3～24个月随访，22枚完全闭塞，1枚留有残颈无变化；患者无再出血，未出现弹簧圈移位和载瘤动脉血栓栓塞事件。结论采用介入栓塞术治疗颅内破裂微小动脉瘤是安全有效的，

Objective To discuss the technical points of endovascular embolization in treating ruptured intracranial tiny aneurysms, and to evaluate the effect and safety of this therapy. Methods A total of 36 patients with ruptured intracranial tiny aneurysms, who were admitted to authors＇ hospital during the period from January 2008 to June of 2013, were enrolled in this study. A total of 36 ruptured intracranial tiny aneurysms were detected. The clinical data, imaging materials, manipulation skill and follow-up findings were retrospectively analyzed. Embolization with steel coil only was performed for 24 ruptured aneurysms, balloon-assisted steel coil embolization was employed for 5 ruptured aneurysms, and stent-assisted steel coil embolization was adopted for 7 ruptured aneurysms. Results During the procedure aneurysm rupture hemorrhage occurred in 2 patients, and one died. Angiography performed immediately after embolization showed that complete ocelusion was achieved in 22 aneurysms （22/36,61.1%） and incomplete occlusion in 14 aneurysms （14/36,38.9%）. Twenty-five aneurysms were followed up for 3-24 months; complete occlusion was seen in 22 aneurysms and neck remnant in one aneurysm. No re-bleeding occurred, and no coil displacement or thrombosis of the parent artery was observed. Conclusion For the treatment of ruptured intracranial tiny aneurysms, endovascular embolization is safe and effective, and in performing interventional procedure it is not necessary to pursue a complete occlusion.