破裂前交通动脉瘤血管内治疗的临床分析

Clinical analysis of endovascular treatment for ruptured anterior communicating artery aneurysms

目的总结破裂前交通动脉瘤血管内治疗的疗效,探讨手术时机、支架使用和并发症的防治。方法回顾性分析连续性血管内治疗76例破裂前交通动脉瘤病人的临床资料,其中行单微导管栓塞71例,双微导管栓塞1例,支架辅助栓塞2例,球囊辅助栓塞2例。并进行影像学和临床随访。结果术前动脉瘤再破裂9例,术中再破裂2例。术后即刻造影Raymond 1级栓塞62例,Raymond 2级栓塞13例,Raymond 3级栓塞1例,完全栓塞率为81.6%。47例行影像学随访(37.3±12.1)个月,复发(Raymond 3级)4例,其中2例发生再破裂。76例病人中预后良好66例,残疾4例,死亡6例,预后良好率为86.8%。结论血管内治疗破裂前交通动脉瘤是一种相对安全、有效的干预方法。

Objective To summarize the therapeutic effect of endovascular treatment for ruptured anterior communicating artery aneurysms （rACoA） for exploring the operation timing, stents using, prevention and treatment of complications. Methods Clinical data of 76 rACoA patients undergoing endovascular treatment were analyzed retrospectively, including embolization by single microcatheter in 71 patients, dual microcatheter in 1, assisted with stents in 2 and assisted with balloon in 2. Imaging and clinical follow-up were performed in the patients. Results Aneurysm rerupture occurred in 9 patients before the operation and 2 in the operation. Raymond grade 1 was achieved in 62 patients, grade 2 in 13 and grade 3 in 1 according to immediate imaging findings after the operation, and the complete occlusion rate was 81.6%. Forty-seven patients were followed up by imaging for 37.3 ±12.1 months. Aneurysm recurred in 4 patients, of whom 2 reruptured. Of 76 patients, 66 had good prognosis, 4 were disabled, 6 died, and the rate of good prognosis was 86.8%. Conclusion Endovascular embolization is a relatively safe and effective intervention method for rACoA.