颈内动脉眼动脉段动脉瘤的血管内治疗

Endovascular embolization treatment of ophthalmic artery aneurysms(report of 36 cases)

目的探讨颈内动脉眼动脉段动脉瘤血管内治疗的疗效。方法回顾性分析2012年9月至2017年11月宁夏医科大学总医院神经外科应用血管内栓塞治疗的36例颈内动脉眼动脉段动脉瘤的临床资料。结果 36例共44枚动脉瘤,其中采用单纯弹簧圈栓塞10枚,LVIS支架辅助栓塞13枚,Enterprise支架辅助栓塞19枚,Neuroform支架辅助栓塞2枚。术后即刻DSA显示Roymond分级Ⅰ级22枚,Ⅱ级20枚,Ⅲ级2枚;栓塞有效率为95.5%。2例栓塞术中发生血栓事件,2例术中动脉瘤破裂,1例术后动脉瘤2次破裂。术后随访4~19个月,改良Rankin量表评分0~2分32例,3~6分4例。30例(34枚)DSA复查,6枚复发。结论血管内栓塞治疗颈内动脉眼动脉段动脉瘤安全有效,积极预防及治疗并发症可改善预后,但需长期随访观察复发情况。

Objective To explore experience in endovascularly treating ophthalmic artery aneurysms,operative complication and the curative effects.Methods The clinical data of 36 patients with 44 ophthalmic artery aneurysms,who were treated by endovascular embolization in our deparment from September,2012 to October,2017,were analyzed retrospectively.Results Of these 44 aneurysms,10 were successfully embolized only with coils,13 with LVIS stent-assisted coils,19 with Enterprise stent-assisted coils and 2 with Neuroform stent-assisted coils.DSA immediately after the embolization showed that 22 received Raymond gradeⅠocclusion(complete occlusion),20 Raymond gradeⅡ(residual aneurysm neck)and 2 Raymond gradeⅢ(residual aneurysm).The effective rate of endovascular embolization was 95.5%(42/44).Thrombosis was observed in 2 and aneurysms ruptured in 2 cases.Aneurysm ruptured in 1 case after endovascular embolization.The following up for 4~19 months after the embolization showed that according to modified Rankin scale,the curative effects were good in 32 cases(88.9%,32/36)and bad in 4 cases.The aneurysms recurred in 6 of 30 followed up with DSA 4~9 months after the embolization.Conclusions The endovascular embolization is a safe and effective method to treat the ophthalmic artery aneurysms.The prevention and treatment of complications can improve curative outcome,but the problem of aneurysm recurrence need long-term observing.