首次造影阴性13例动脉瘤性蛛网膜下腔出血患者临床分析

Clinical analysis of 13 cases of negative result of initial subtraction angiography in patients with subarachnoid hemorrhage

目的探讨首次全脑血管造影阴性的动脉瘤性蛛网膜下腔出血患者的临床特点及治疗经验。方法回顾分析我科自2009-01—2015-12收治的首次DSA呈阴性,二次造影发现动脉瘤13例蛛网膜下腔出血患者的临床资料。结果 13例患者中动脉瘤部位:前交通动脉瘤6例,大脑中动脉瘤3例,胼周动脉瘤2例,眼动脉段动脉瘤2例;动脉瘤的大小及瘤颈情况:直径2~3mm动脉瘤7例(窄颈5例),4~5mm动脉瘤6例(窄颈5例)。结论微小或窄颈动脉瘤性蛛网膜下腔出血患者首次造影可能存在假阴性,及时复查DSA并给予适宜治疗,对改善患者预后十分重要。

Objective To investigate the clinical features and treatment strategy for patients with aneurysmal spontaneous subarachnoid hemorrbage （SAH） and a negative result in the first digital subtraction angiography （DSA）. Methods The clinical data were retrospectively evaluated in 13 patients with aneurysm SAH,who were treated in our hospital with a negative result in the first DSA. Results Aneurysms were found in 13 cases including anterior communicating artery aneurysm （7 cases）, middle cerebral artery aneurysm （3 cases） ,pericallosal artery aneurysms （2 cases） ,and ophthalmic artery aneurysm （2 cases）. The size of the aneurysm neck and tumor：2-3 mm diameter aneurysm in 7 cases （5 cases for narrow neck）;4-5 mm aneurysm in 6 cases （5 cases for narrow neck）. Conclusion For patients with aneurysm SAH with narrow neck or small aneurysm,the result of first DSA may be negative, repeated angiography and given a right treatment play important roles.