破裂前交通动脉复合体动脉瘤66例血管内治疗回顾性分析

Endovascular treatment of ruptured aneurysms located at anterior communicating artery complex： a sixty-six cases report

目的探讨破裂前交通动脉复合体（ACoAC）动脉瘤的血管内治疗经验。方法回顾性分析2013年5月至2014年12月于第四军医大学西京医院就诊的66例破裂ACoAC动脉瘤病例资料。男性50例，女性16例；年龄31～69岁，平均年龄（51±8）岁。人院时Hunt．Hess分级：I级13例，Ⅱ级36例，Ⅲ级11例，Ⅳ级6例。动脉瘤瘤体最大径≤3mm者14例，〉3mm且≤7mm者36例，〉7mm者16例。绝对宽颈动脉瘤8例，相对宽颈50例，窄颈8例。血管内治疗采用动脉瘤弹簧圈栓塞术，包括单微导管栓塞法28例，双微导管栓塞法18例。支架辅助法14例和球囊辅助法6例。术后随访6～12个月，行改良Rankin评分并复查数字减影血管造影（DSA）。以栓塞方法分组，采用X2检验或F检验比较组问即刻完全栓塞率、复发率及DSA复查时间。结果完全栓塞60例，次全栓塞3例，不完全栓塞3例；2例术后并发轻偏瘫伴失语，1例死亡。术后6个月改良Rankin评分0级31例、1级22例、2级8例、3级2例、4级2例、5级0例、6级l例。66例在术后平均（7．5±1．0）个月复查DSA，4例复发。不同栓塞方法组问即刻完全栓塞率、复发率、DSA复查时间无明显差别（P均〉0．05）。结论基于动脉瘤形态和载瘤动脉空间走行，

Objective To investigate the endovascular treatments for the ruptured aneurysms located at anterior communicating artery complex （ACoAC）. Methods The data of patients with ruptured ACoAC aneurysms treated in Department of Neurosurgery, First Affiliated Hospital to Fourth Military Medical University from May 2013 to December 2014 was retrospectively analyzed. Sixty-six cases were recruited including 50 male and 16 female patients. The patients aged from 31 to 69 years old, averaging （51±8） years. The Hunt-Hess grade at admission were 13 cases with grade I , 36 cases with grade Ⅱ , 11 cases with grade Ⅲ and 6 cases with grade IV. The most diameter of aneurysms sac ： 14 cases less than or equal to 3 mm, 36 cases more than 3 mm but less than or equal to 7 mm, and 16 cases more than 7mm. The height diameter/neck width ratio： 8 cases with absolute wide neck, 50 cases with relatively wide neck, and 8 cases with narrow neck. There were 28 cases underwent single micro-catheter embolization, 18 cases underwent double micro-catheters embolization, 14 cases underwent stent-assisted embolization and 6 cases underwent balloon-assisted embolization. The patients were followed up for 6 to 12 months and evaluated by modified Rankin score （mRS） and digital subtraction angiography （DSA）. The ratio of total embolization, recurrence rate, and time from operation to reexamination of four groups managed by different endovascular treatment were compared by X2 test or F test. Results Sixty cases were totally emholized, 3 cases subtotally embolized, 3 cases incompletely embolized. Mild hemiparalysis and aphasia occurred in 2 cases, and 1 case died of infarction induced by subarachnoid haemorrhage. The mRS at six months after operation were 0 in 31 cases, 1 in 22 cases, 2 in 8 cases, 3 in 2 cases, 4 in 2 cases, 6 in 1 case. All the included casesreexamined tile I）SA at averaging （7.5 ±1.0） month post-operatively and 4 eases recurred. There were not significant differences of the ratio of total embolization, recurrence rate, time from operation to reexamination among four groups （ all P 〉 0. 05 ）. Conclusion The endovaseular treatment maybe an ideal management tbr ruptured ACoAC aneurysms.