电解可脱弹簧圈栓塞治疗颅内宽颈动脉瘤

目的 总结电解可脱弹簧圈栓塞治疗60例67个颅内宽颈动脉瘤的体会,探讨颅内宽颈动脉瘤介入治疗方法、技术操作要点、存在问题及临床应用前景。方法 60例颅内动脉瘤患者中54例为破裂动脉瘤。采用双弯塑形、横向成篮、分部填塞及篮外填塞等方法治疗55例,瘤颈重塑形技术2例,血管内支架结合GDC 3例。结果 栓塞程度:颅内动脉瘤完全栓塞54个(54/67),栓塞90％以上9个(9/67),栓塞90％以下4个(4/67)。术中出血2例(2/60),死亡2例(2/60)。结论 GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。改进栓塞技巧及瘤颈塑形技术等方法,可以明显提高宽颈动脉瘤的完全栓塞率,血管内支架结合GDC可能成为治疗颅内梭形及宽颈动脉瘤的有效方法。

Embolization of Intracranial Wide Necked Aneurysms Using Guglielmi Detachable Coils

Objective To assess the method, technique key, effects and the prospect of clinical use of the intervenient treatment for intracranial wide necked aneurysms. Methods Sixty seven intracranial wide necked aneurysms including 54 ruptured aneurysms were embolized by Guglielmi detachable coils (GDCs) in 60 patients. Of 60 patients, 55 were treated by the techniques of double-angled shaping, transverse basket, packing by stages and extrabasket packing, 2 by remodeling of the aneury-smal necks, and 3 by combined techniques of endovascular stents and GDCs. Results Total occlusion was achieved in 54 aneurysms (54/67), over 90% in 9 aneurysms (9/67), less than 90% in 4 aneurysms (4/67). Intraoperetive hemorrhage occurred in 2 patients (2/60) and 2 patients died after the surgery. Conclusions The results suggest that the embolization of intracranial aneurysms with GDCs is minimally invasive, safe, effective and reliable. Using improved embolizing techniques including the remodeling technique may favorably increase the total occlusion rate in the wide necked aneurysms. Endovascular stent implantation in combination with microcoil placement may become a valid alteration for the treatment of fusiform or wide-necked intracranial aneurysms.