颅内破裂微小动脉瘤血管内治疗的安全性和有效性

Safety and efficacy of endovascular treatment for ruptured tiny intracranial aneurysms(report of 53 cases)

目的探讨颅内破裂微小动脉瘤血管内治疗的安全性及有效性。方法回顾性分析2016年1月至2017年12月收治的53例颅内破裂微小动脉瘤的临床及随访资料,均采用血管内治疗。结果动脉瘤最大直径平均(2.19±0.55)mm。单纯弹簧圈栓塞27例,球囊辅助栓塞2例,支架辅助栓塞24例;术后即刻造影显示动脉瘤致密栓塞24例(45.3%),瘤颈残留16例(30.2%),瘤体显影13例(24.5%)。共3例(5.7%)发生围术期并发症,其中1例(1.9%)为术中破裂,1例(1.9%)为术中血栓形成,1例(1.9%)为术后早期再出血。39例影像学随访3·13个月,平均平均(6.1±2.4)个月,动脉瘤不显影32例(82.1%);稳定3例(7.7%);复发4例(10.3%),均再治疗。51例临床随访6~28个月,平均(14.9±6.6)个月,改良Rankin量表评分0~2分50例(98.0%),3分1例(2.0%)。结论对于颅内破裂微小动脉瘤,血管内治疗具有较高的围手术期安全性,以及较高的短期治愈率和临床预后良好率。

Objective To assess the safety and short-term efficacy of endovascular treatment for ruptured tiny intracranial aneurysms.Methods The clinical and follow-up data of 53 patients with ruptured tiny intracranial aneurysms who were treated with endovascular treatment from Januray,2016 to December,2017 were retrospectively reviewed.Results The mean aneurysms size was(2.19±0.55)mm.Of these 53 patients,27 patients were treated with simple coil embolization,2 with balloon-assisted coiling and 24 with stent-assisted coiling.Immediate angiographic results showed that Raymond gradeⅠocclusion of aneurysm was achieved in 24(45.3%)patients,gradeⅡin 16,gradeⅢin 13.Periprocedural complications occurred in 3(5.7%)patients:intraprocedural aneurysm rupture in 1(1.9%),intraprocedural thrombosis in 1(1.9%)and postoperative aneurysm rebleeding in 1(1.9%).Angiographic follow-up of 39 patients(mean,6.1 months)showed that complete occlusion of aneurysm was achieved in 32(82.1%)patients,stabilization in 3(7.7%)patients,recurrence in 4(10.3%)patients receiving retreatment.Clinical follow-up of 51 patients(mean,14.9 months)showed that 50(98.0%)patients had a favorable neurological outcome(mRS score of 0~2)and 1(2.0%)had a poor neurological outcome(mRS score of3).Conclusions Endovascular treatment of ruptured tiny intracranial aneurysms is safe and effective,with high rates of complete occlusion of aneurysm and favorable neurological outcomes at follow up.