球囊辅助弹簧圈联合Onyx胶栓塞治疗颅内大型或宽颈动脉瘤

Endovascular treatment of large or wide neck intracranial aneurysms by balloon-assisted coils combined with Onyx glue

目的探讨弹簧圈联合Onyx胶栓塞治疗颅内大型或宽颈动脉瘤的可行性及有效性。方法回顾性分析2014年11月2016年10月收治15例颅内大型或宽颈动脉瘤的临床资料,其中采用单纯弹簧圈栓塞治疗5例,采用支架辅助弹簧圈栓塞治疗4例,采用球囊辅助弹簧圈联合Onyx胶栓塞治疗6例。结果术后立即造影示动脉瘤完全栓塞12例,部分栓塞3例。1例因年龄较大拒绝随访,其余14例栓塞术后随访6~12个月;单纯弹簧圈栓塞治疗的4例中,复发3例;支架辅助弹簧圈栓塞治疗的4例中,复发1例;球囊辅助弹簧圈联合Onyx胶栓塞治疗的6例均无复发,但2例大脑后动脉P3~P4段巨大夹层动脉瘤出现载瘤动脉远端动脉闭塞。结论球囊辅助弹簧圈联合Onyx胶治疗颅内大型或宽颈动脉瘤可提高动脉瘤的栓塞率,减少复发率。

Objective To assess the feasibility and effectiveness of endovascular treatment for large or wide neck intracranial aneurysms by balloon-assisted coils combined with Onyx glue. Methods The clinical data of 15 patients with large or wide neck intracranial aneurysms, of whom, 5 were embolized by coils, 4 by stent-assisted coils, and 6 by balloon-assisted coils combined with onyx glue, were analyzed retrospectively. Results The following up ranging from 6 to 12 months showed that aneurysm recurrence occurred in 3 of 5 patients who were embolized only by coils, aneurysm recurrence occurred in 1 of 4 by stent-assisted coils, and no aneurysm recurrence occurred in 6 by balloon-assisted coils combined with Onyx glue. Two patients with giant dissection aneurysms located in the third and fourth segments of posterior cerebral arteries suffered from the occlusion of the parent artery distal segment after embolization by balloon-assisted coils combined with Onyx glue. Conclusion For large or wide neck intracranial aneurysms, embolization by balloon-assisted coils combined with Onyx glue may help to increase the rate of complete aneurysm occlusion and decrease the rate of aneurysm recurrence.