电解可脱性弹簧圈栓塞颅内动脉瘤相关问题的探讨

An analysis of the related problems in endovascular treatment of intracranial aneurysms with Guglielmi detachable coils

目的 总结使用电解可脱性弹簧圈 (GDC)栓塞颅内动脉瘤时旋转DSA的应用及GDC操作要点。方法 对 38例共 4 0个颅内动脉瘤常规行旋转DSA检查 ,动脉瘤直径 4～ 2 5mm ,平均(12 5 1± 5 37)mm。瘤体直径 <12mm的小动脉瘤 2 9个 ,12～ 2 5mm的大动脉瘤 11个。术前Hunt Hess分级Ⅰ～Ⅳ级分别是 2 6例、8例、3例、1例。随后使用GDC栓塞治疗。结果 37例 39个颅内动脉瘤栓塞成功 ,1例死亡。完全栓塞 (>95 % ) 2 2个 ,大部分栓塞 (80 %～ 95 % ) 12个 ,部分栓塞(<79% ) 5个。并发动脉瘤破裂 2例 ,治疗后痊愈。并发脑动脉痉挛 6例 ,治疗后 2例遗留轻偏瘫和单瘫。 2例弹簧圈部分遗留于动脉瘤外 ,经抗凝治疗未发生并发症。 2例复发再次栓塞后痊愈。结论GDC栓塞治疗颅内动脉瘤是 1种安全、可靠、有效的治疗方法。合理应用旋转DSA技术。

Objective To summarize the results of technical tip of rotational DSA and using Guglielmi detachable coils(GDC) in the treatment of intracranial aneurysms. Methods Thirty eight patients with 40 intracranial aneurysms were treated with GDCs after rotational DSA was performed. Results Thirty seven patients with 39 aneurysms were successfully embolized with GDCs, but one case died. Total occlusion (>95%)was achieved in 22 cases, 80%-95% embolization in 12 and occlusion less than 79% in 5. Two aneurysms ruptured during the performance, and all cured after treatment. Six patients had vascular spasm, 4 of them were cured after treatment, and 2 patients had cerebral infarction that resulted in permanent slight monoplegia. A small part of GDC was kept staying in the parent artery, but no complication ensued after anticoagulation treatment. Two recurring cases were cured by the second GDC embolization. Conclusion Treatment for intracranial aneurysms with GDCs is a safe, reliable, and effective method. Accurate diagnosis and secure treatment can be achieved by using rotational DSA and performing GDCskillfully.