颅内动脉瘤血管内介入栓塞术中再次破裂出血紧急处置

目的 探讨颅内动脉瘤性蛛网膜下腔出血患者在接受血管内介入栓塞术中动脉瘤再次破裂出血的原因、紧急处置及防治措施.方法 回顾性分析2011年1月至2016年10月连续收治的颅内破裂动脉瘤介入栓塞术中再次发生破裂出血患者临床资料,系统研究其影像学特征、栓塞材料选择及技术操作特点.结果 510例接受介入栓塞患者中共发生术中动脉瘤再次破裂出血11例,发生率为2.2％,其中8例为弹簧圈突破,2例为微导管穿破,1例为辅助支架内急性血栓形成于溶栓过程中再次出血.经过积极紧急处置,10例预后良好,无明显神经功能缺损,1例死亡.结论 颅内动脉瘤栓塞术中破裂出血是一种严重,甚至灾难性并发症,原因多为弹簧圈突破,其次为微导管突破.但只要采取积极、合理的处置措施,致残致死率可大为降低.

Emergency management of intraoperative re-rupture of intracranial aneurysm with bleeding during endovascular interventional embolization procedure

Objective To investigate the causes of intraoperative re-rupture of intracranial aneurysm with bleeding during endovascular interventional embolization procedure in patients with subarachnoid hemorrhage due to intracranial aneurysm,and to discuss its emergency treatment and prevention measures.Methods The clinical data of 11 patients with intracranial aneurysm,who were admitted to authors' hospital during the period from January 2011 to October 2016 and in whom intraoperative re-rupture of intracranial aneurysm with bleeding occurred in endovascular interventional embolization procedure,were retrospectively analyzed.The imaging features,the selection of embolization material and the key point of technical operation were evaluated.Results A total of 510 patients with intracranial aneurysmal subarachnoid hemorrhage received interventional embolization therapy,and among them 11 patients developed intraoperative re-rupture of intracranial aneurysm with bleeding,with the incidence being 2.2％.The cause of re-rupture was mainly due to the perforation of vascular wall by spring coil (n=8) or by micro-catheter (n=2).In the remaining one patient,re-bleeding occurred during the thrombolytic treatment for acute in-stent thrombosis.Through active emergency treatment,satisfactory prognosis was obtained in 10 patients,and no obvious neurological deficit was observed.One patient died.Conclusion Intraoperative re-rupture of intracranial aneurysm with bleeding during endovascular interventional embolization procedure is a severe,even catastrophic,complication.The main cause of re-rupture is due to the perforation of vascular wall mainly by spring coil or occasionally by micro-catheter.However,as long as positive and reasonable treatment measures are promptly adopted,its mortality and morbidity can be greatly reduced.