颈内动脉-后交通段动脉瘤的血管内治疗临床研究

Clinical study on internal carotid artery-posterior communication artery aneurysm

目的探讨颈内动脉-后交通段动脉瘤血管内治疗的安全性及有效性。方法宁夏医科大学总医院神经外科于2014年1月至2017年9月应用血管内栓塞治疗颈内动脉后交通段动脉瘤患者70例,其中17例为双侧颈内动脉-后交通段动脉瘤。分析其影像学资料、栓塞方案、栓塞率、并发症、随访结果及预后。总结颈内动脉-后交通段动脉瘤栓塞治疗的经验及注意事项。结果根据术后即刻栓塞Roymond分级,本组患者中Ⅰ级者42例,Ⅱ级19例,Ⅲ级9例,栓塞有效率为87. 1%(61/70)。其中2例微小动脉瘤,因弹簧圈无法植入,单纯应用支架贴覆; 5例患者术中动脉瘤破裂出血,均经继续填塞止血成功,2例患者于术后再次出血行开颅夹闭动脉瘤术,其中1例患者死亡,1例患者预后良好,另外3例术中破裂继续填塞患者的预后良好。术后随访6个月～2年,经改良Rankin评分,0～2分者57例,3～6分者13例,预后良好率81. 4%。结论血管内治疗颈内动脉-后交通段动脉瘤安全、有效,预后良好。

Objective To explore the safety and efficacy of endovascular treatment for internal carotid artery aneurysm. Methods The clinical data of 70 patients with internal carotid artery aneurysms underwent endovascular embolization in General Hospital of Ningxia Medical University from January 2014 to September 2014, were collected （17 cases were bilateral internal carotid artery-posterior communication artery aneyrysms）. The imaging data, embolization scheme, embolization rate, complications, follow-up resuhs and prognosis were analyzed. The treatment experience and attention to the treatment of internal carotid artery aneurysm embolization were summarized. Results According to the postoperative immediate embolization of Roymond, of 70 patients, 42 belonged in grade I , 19 in grade Ⅱ and 9 in grade Ⅲ ,and the embolization rate was 87.1% （61/70）. Among them,2 cases were small aneurysms, the spring coil could not be implanted, and the stent was applied only. 5 cases of aneurysm rupture hemorrhage, 2 of which were decompression of bone plate after operation. The follow-up for 6 months to 2 years showed t he mRS score was 0-2 points including 57 cases and 3-6 points including 13 cases. Conclusion Endovascular treatment of internal carotid artery-posterior segment aneurysms is safe and effective with good prognosis.