颅内宽颈动脉瘤的血管内介入治疗

目的：总结血管内介入治疗颅内宽颈动脉瘤的技术及操作方法，并分析其临床疗效。方法：39例经头颅CTA和／或全脑血管造影确诊的颅内宽颈动脉瘤，其中未破裂动脉瘤9例；破裂动脉瘤30例，按Hunt—Hess分级标准，Ⅰ级8例、Ⅱ级17例、Ⅲ级4例、Ⅳ级1例。根据动脉瘤的具体位置、大小、形态及与载瘤动脉的关系分别采用3D弹簧圈网篮编织技术、血管内支架辅助弹簧圈栓塞技术、瘤颈重塑形技术、双导管技术，选用合适的弹簧圈逐步填塞治疗。结果：完全栓塞31例（79．4％），大部栓塞8例（20．6％）。无术中出血病例。术中共置人164枚弹簧圈，15枚支架。术后第7天，1例患者因肾功能衰竭及严重的肺部感染死亡。38例患者出院后3个月依据GOS评分评价疗效，恢复良好（GOS5／4分）34例、轻度残疾（GOS3分）2例、重度残疾（GOS2分）2例。其中21例术后随访6～36个月，分别于术后6个月或16个月或36个月行全脑血管造影，未见动脉瘤复发。结论：绝大部分颅内宽颈动脉瘤通过选用合适的血管内辅助技术及方法能够得到成功的栓塞治疗。

Interventional Therapy for Intracranial Wide - necked Aneurysms

Objective：To summarize and analyze the experience of various techniques and methods a- bout the interventional therapy of intracranial wide -necked aneurysms. Methods：39 patients with intraeranial wide - necked aneurysms confirmed by head CTA and / or cerebral angiography. Among them ,9 cases were un- ruptured aneurysms, and 30 eases were ruptured aneurysms, 8 cases of grade Ⅰ, 17 cases of grade Ⅱ, 4 cases of grade Ⅲ, 1 case of grade Ⅳ according to Hunt - Hess classification. According to the specific location of the aneurysm, the size, shape and the relationship with the parent artery, techniques were chosen, including the 3D coil basket weaving techniques, endovascular stent assisted coil embolization, aneurysm neck remodeling fractal technology, dual - catheter technique appropriate choice of spring till the coil gradually filling satisfac- tion. Results：Complete embohzation in 31 cases （79.4%） , 8 cases of embolism （20.6%）, no case bleeding intraoperative,cpc surgery coil placed 164, 15 brackets, 1 death occurred after 7 days due to renal failure and serious lung infection. 3 months after discharge GOS score ： good recovery （ GOS 5/4） 34 cases, mild disability （ GOS 3） 2 cases of severe disability （ GOS 2） 2 cases. 21 patients were followed up for 6 to 36 months, at 6th month or 16th month or 36th month total cerebral angiography, no aneurysm recurrence. Conclusions ：The ma- jority of intracranial wide - necked aneurysms through the selection of appropriate intravascular assistant tech- nologies and methods can be successful embolization.