血管内治疗颈内动脉床突旁破裂动脉瘤

Endovascular embolization of ruptured paraclinoid aneurysms(report of 26 cases)

目的 探讨血管内治疗颈内动脉床突旁破裂动脉瘤的临床效果。方法 2011年1月至2014年12月血管内治疗颈内动脉床突旁破裂动脉瘤26例。结果 单纯弹簧圈栓塞治疗11例,支架辅助弹簧圈栓塞治疗15例。术后即刻造影示：Raymond分级Ⅰ级15例,Ⅱ级8例,Ⅲ级3例。术中发生并发症9例,其中1例术中再次破裂,最后死亡。25例术后平均随访6个月,无动脉瘤再破裂出血;5例复发,其中3例再次支架辅助弹簧圈栓塞治疗;改良Rankin量表评分评估患者预后：预后良好（0-2分）23例,预后差（3-6分）2例。结论 血管内治疗颈内动脉床突旁破裂动脉瘤仍存在挑战,常需使用支架辅助技术,尽管存在一定复发率,但近期仍可达到很好的临床效果。

Objective To analyze the clinical curative effects of endovascular embolization on the ruptured paraclinoid aneurysms. Methods The clinical data of 26 patients with ruptured paraelinoid aneurysms undergoing endovascular embolization from January, 2011 to December, 2014 were analyzed retrospectively. Angiographic results were evaluated with the Raymond grading system, whereas clinical outcomes were evaluated with the modified Rankin scale （mRS） after the embolization. Results Of 26 patients with ruptured paraclinoid aneurysms, 11 were treated by coil embolization and 15 by stent-assisted coiling. The complete occlusion of the aneurysms was achieved in 15 patients, there was aneurismal neck remnant in 8 and incomplete occlusion was achieved in 3 immediately after the initial treatment. One patient died from aneurismal rupture during the operation. Of 25 patients, 23 were recovered well and 2 badly according to mRS. No aneurysms ruptured again in 25 patients followed up averagely for 6 months. The aneurysms recurred in 5 patients who underwent stent-assisted coil embolization again. Conclusion The ruptured paraclinoid aneurysms should be treated by stent-assisted endovascular embolization because its effect on them and safety are good.