颅内动脉瘤破裂出血后假性动脉瘤形成的实验和临床研究

Basic and clinical research on false aneurysm forming after the rupture of intracranial aneurysm

目的探讨颅内动脉瘤破裂出血后在其破口周围可以形成假性动脉瘤,对其应早期诊断尽快治疗,防止再出血,提高治愈率,降低死残率。方法通过用兔建立的假性动脉瘤与真性动脉瘤合并假性动脉瘤的动物模型,探讨假性动脉瘤形成的机理,并结合临床在治疗颅内动脉瘤破裂出血早期、DSA造影影像分析及GDC血管内栓塞动脉瘤时所见的情况进行分析。结果用创伤与显微外科相结合的方法,可以成功建立假性动脉瘤,其形成过程分为动脉瘤破裂出血期、假性动脉瘤形成前期、假性动脉瘤形成期及假性动脉瘤增大破裂出血期四个阶段。颅内动脉瘤破裂出血早期行DSA血管造影时可见其影像形态不规则呈哑铃状、双腔与瘤囊顶鼓出小泡等表现,血管内栓塞治疗可见(1)GDC只能进入靠近载瘤动脉的瘤腔,并将其栓塞,完全不进入远离载瘤动脉的瘤腔,栓塞后透视下见未充填GDC的瘤腔内有造影剂滞留,栓塞后造影见动脉瘤完全闭塞,随访造影见动脉瘤完全消失;(2)GDC完全填塞靠近载瘤动脉的瘤腔,部分填塞远离载瘤动脉的瘤腔,栓塞后造影见动脉瘤完全消失,随访造影动脉瘤消失;(3)GDC将靠近与远离载瘤动脉的两个瘤腔完全填塞,栓塞后造影见动脉瘤完全闭塞,随访造影见动脉瘤消失。结论颅内动脉瘤破裂出血后,在其破口周围可以形成假性动脉瘤。

Objective To investigate the mechanism of false aneurysm (FA) forming after rupture of intracranial aneurysm, to enhance cure rate and decrease mortality and morbidity. Methods The models of FA and true aneurysm complicated by FA were established in rabbits. The processes of forming FA were relorded. The status of early phase of ruptured intracranial aneurysm was observed by DSA and analyzed in the patients with aneurysm. Results The process of FA forming could divided into four phases: rupture and hemorrhage of aneurysm; preforming of FA; forming of FA; enlargement and rupture of FA. In early phase of rupture and hemorrhage of intracranial aneurysm, the irregular images such as dumbbell-like shape; double cavity and prosection of aneurysm sac top were clinically observed on DSA. (1)The aneurysmal lumina proximal, not distal to the feeding arteries could be filled and embolized with GDC. The repeated angiography after the embolization and during follow-up phase showed that the aneurysm disappeared. (2)The aneurysmal lumina proximal to feeding arteries were tightly filled with GDC; the lumina distal to the feeding arteries were partly filled with GDC, the repeated angiography after embolization and during follow-up phase showed that the aneurysm disappeared. (3)Both lumina of aneurysm can be filled with GDC. The repeated angiography after embolization and during follow-up phase showed that the aneurysm disappeared. Conclusions FA can form around the ruptured aneurysm, early clipping the neck of aneurysm or endovascular embolization play an important role in preventing secondly hemorrhage and decrease morbidity and mortality.