颅内动脉瘤破裂急性期的电解可脱式弹簧圈栓塞治疗技巧与并发症

Techniques and complications in endovascular embolization on acute ruptured intracranial aneurysms with Guglielmi detachable coils

目的总结颅内动脉瘤破裂急性期的电解可脱式弹簧圈(GDC)栓塞治疗操作技巧、并发症及其防治经验。方法1998年10月至2002年10月我科用GDC栓塞治疗破裂急性期颅内动脉瘤41例,动脉瘤大小3.6～25mm;位于Willis环前循环39例,后循环2例。结果术后造影100%栓塞33例,90%～99%栓塞5例,90%以下栓塞3例。产生与栓塞技术相关的并发症6例,与蛛网膜下腔出血相关的并发症5例。平均住院时间12 d;术后随访12～48个月,无再出血,恢复良好36例,中度致残,生活能自理4例,死亡1例。结论GDC栓塞治疗急性期的破裂颅内动脉瘤安全有效。正确处理术中并发症,提高栓塞技术有助于减少术后并发症,提高治愈率。

Objective To summarize the techniques and managements of complications in endovascular embolization on acute ruptured intracranial aneurysms with Guglielmi detachable coils (GDC). Methods There were 41 patients with acute ruptured intracranial aneurysms treated with early GDC embolization within 72 hours after the rupture. The diameters of aneurysms ranged from 3.6mm to 25mm. Among them, 39 aneurysms located in the anterior circulation, and 2 in posterior circulation. Results Complete obliteration (100%) was in 33 cases, while 90%-99% in 5 cases and below 90% in 3 cases. The technique-related complications were present in 6 cases, and 5 patients suffered from the complications of SAH. The average hospitalization time was 12 days. No re-rupture occurred in the 12-to-48-month follow-up. 36 patients showed good recovery, 4 patients showed moderate disability and 1 patient died. No patient showed severe disability or was in vegetative state. Conclusion GDC occlusion is a safe and effective treatment for the acute ruptured intracranial aneurysms. Advances in the techniques and treating the complications correctly will decrease the complications and improve future outcomes.