眼动脉段动脉瘤血管内栓塞治疗方法探讨

Discussion on the endovascular embolization treatment of ophthalmic segment aneurysms

目的 探讨颈内动脉眼动脉段动脉瘤血管内栓塞治疗方法及技术要点。方法 回顾性分析2012年5月至2015年4月郑州大学第一附属医院采用血管内栓塞术治疗48例眼动脉段动脉瘤患者影像及临床资料、治疗效果及随访结果，探讨治疗方法及技术要点。结果 48例患者49枚动脉瘤均栓塞成功，其中单纯弹簧圈栓塞17枚（双微导管3枚），球囊辅助栓塞2枚，支架辅助栓塞28枚（Leo支架3枚，Lvis支架5枚，Enterprise支架14枚，Solatire AB支架6枚），Willis覆膜支架隔绝1枚，Pipeline密网支架植入1枚。术后即刻DSA造影显示，Raymond栓塞分级Ⅰ级34枚（69%），Ⅱ级9枚（18%），Ⅲ级6枚（13%）。术中发生支架内血栓形成2例。48例均达到临床治愈，出院时改良Rankin 量表（mRS）评分0分44例，1分2例，4分2例（该2例治疗前≥4分）；出院后3个月至1年mRS评分0分46例，2分1例，4分1例，均无新发神经功能障碍及出血。20例DSA随访1～21个月，18例痊愈，1例明显好转， 1例明显复发，再次手术致密栓塞。结论 血管内栓塞治疗眼动脉段动脉瘤是一种微创、安全有效的方法，选择不同栓塞技巧是保证手术成功、减少术后并发症、提高治愈率的关键。

Objective To discuss the therapeutic method and technical points of endovascular embolization treatment for ophthalmic segment aneurysms of internal carotid. Methods The imaging materials, clinical data, therapeutic efficacy and follow-up results of 48 patients with ophthalmic segment aneurysm, who were admitted to the First Affiliated Hospital of Zhengzhou University to receive endovascular embolization treatment during the period from May 2012 to April 2015, were retrospectively analyzed. The treatment scheme and technical points were discussed. Results A total of 49 ophthalmic segment aneurysms were detected in 48 patients, and all aneurysms were successfully obstructed. Endovascular treatments included simple coil embolization （n=11, using double microcatheter technique in 3 aneurysms）, balloon- assisted embolization （n=2）, stent-assisted coil embohzation （n=28, including 3 Leo stents, 5 Lvis stents, 14 Enterprise stents and 6 Solitaire AB stents）, Willis covered stent isolation （n=1） and dense-mesh pipeline stent implantation （n=l）. DSA performed immediately after the treatment revealed that grade Ⅰ , Ⅱ and Ⅲ of Raymond embolization classification were obtained in 34 （69%）, 9 （18%） and 6 （13%） aneurysms respectively. During the procedure, in-stent thrombosis was observed in 2 cases. Clinical cure was achieved in all 48 patients. At the time of discharge, the modified Rankin scale （mRS） score was 0 point in 44 patients, one point in 2 patients and 4 points in 2 patients （the preoperative score of these 2 patients was ≥4points） ; and 3-12 months after discharge from hospital the mRS score was 0 point in 46 patients, 2 points in one patient and 4 points in one patient. No new neurological dysfunction or bleeding occurred in all patients. Follow-up DSA examination performed within 1-21 months after treatment showed that complete cure was achieved in 18 patients, obvious improvement was obtained in one patient, and recurrence was seen in one patient and for this patient total occlusion of the aneurysm had to be carried out again. Conclusion For the treatment of ophthalmic segment aneurysms, endovascular embolization is a minimally-invasive, safe and effective method. The use of different embolization techniques is the key to ensure the success of the operation, to reduce the postoperative complications and to improve the cure rate.