DSA应用于颅内复杂动脉瘤介入杂交手术中的临床价值

目的探讨介入杂交手术平台治疗颅内复杂动脉瘤的效果,并观察数字减影血管造影技术(DSA)在手术治疗前后的评估价值。方法采用Solitaire AB支架辅助弹簧圈栓塞治疗颅内动脉瘤17例(共23个动脉瘤),同时比较2D数字减影血管造影技术(2D-DSA)、3D数字减影血管造影技术(3D-DSA)在颅内动脉瘤检出率方面的差异。结果 17例病理证实为颅内动脉瘤患者中2D-DSA共检出16例,1例微小血泡样宽颈动脉瘤因病灶太小漏诊,准确率为94.12%,3D-DSA全部检出,准确率达100.0%,但两种检测方式比较差异无统计学意义(t=1.030,P=0.310)。15例宽颈动脉瘤术中达到致密栓塞;2例未破裂颈内动脉巨大宽颈动脉瘤予以较疏松填塞。1例双侧大脑中动脉宽颈动脉瘤患者因术前出血量大,栓塞治疗后行开颅清除血肿、去骨瓣减压术。全组无死亡病例。术后随访3-30个月,16例恢复工作,1例呈迁延性昏迷状态(治疗3个月)。复查DSA16例动脉瘤消失,1例疏松填塞的巨大颈内动脉宽颈动脉瘤患者,瘤腔仍有血流灌注,但动脉瘤未增大。结论支架辅助弹簧圈栓塞技术能够有效提髙颅内复杂宽颈动脉瘤栓塞治疗的成功率,同时可有效防止再出血,提髙复杂动脉瘤的治愈率,期间应用DSA技术可确保治疗安全性,并对预后做出可靠判断。

Clinical Value of DSA in Interventional Hybrid Operation of Intracranial Complex Aneurysms

Objective To investigate the effects of interventional hybrid operation in the treatment of intracranial complex aneurysms and to observe the evaluation value of digital subtraction angiography (DSA) before and after surgical treatment.Methods 17 patients (23 aneurysms) with intracranial aneurysms were treated with SolitaireAB stent assisted coil embolization. The differences in the detection rate of intracranial aneurysms between 2D digital subtraction angiography (2D-DSA) and 3D digital subtraction angiography (3D-DSA) were compared.Results Among the 17 patients with pathologically confirmed intracranial aneurysms, 16 patients were detected by 2D-DSA. 1 case of small bleeding blister like wide carotid aneurysm was missed diagnosed because the lesion was too small and the accuracy rate was 94.12%. All were detected by 3D-DSA and the accuracy rate was 100.0%. However, there was no significant difference between the two detection methods (t=1.030, P=0.310). 15 cases of wide carotid aneurysms reached tight embolization during operation; 2 patients with large wide carotid aneurysms without ruptured internal carotid artery were given relatively looser packing. 1 patient with wide carotid aneurysm in bilateral middle cerebral artery was treated with craniotomy for removing hematoma and decompressive craniectomy after embolotherapy because of preoperative massive hemorrhage. There were no deaths in the whole group. The patients were followed up for 3-30 months after operation. 16 patients returned to work and 1 patients were in persistent coma (treated for 3 months). DSA reexamination found that 16 cases of aneurysms disappeared and there still was blood perfusion in tumor cavity of 1 patients with wide internal carotid aneurysms treated with loose packing but the aneurysm was not enlarged.Conclusion Stent assisted coil embolization technique can effectively improve the success rate of embolotherapy for treating intracranial complex wide carotid aneurysms. It can effectively prevent rebleeding and increase the cure rate of complex aneurysms. During the treatment, the application of DSA technique can ensure the safety of the treatment and make reliable judgments to prognosis.