三维CT血管造影在电解脱弹簧圈栓塞急性破裂脑动脉瘤中的临床价值

目的 评估三维CT血管造影(3D—CTA)在电解脱弹簧圈(GDC)栓塞破裂脑动脉瘤(AN)中的临床价值。方法 对175例连续收治的急性自发性蛛网膜下腔出血(SAH)患者,在人院当天行急诊3D—CTA检查,根据3D—CTA的结果,凡符合栓塞指征的AN患者在3d内行GDC栓塞术。结果 80例符合条件的破裂AN成功地进行了GDC栓塞,脑数字减影血管造影(DSA)全部证实了3D—CTA的发现,3D—CTA在显示AN和载瘤动脉的三维结构上优于DSA。它能在脑血管造影前为AN的栓塞提供有价值的信息,尤其对前交通AN的栓塞。结论 3D—CTA可在脑血管造影前早期确定AN和栓塞指征;可引导导管直接置入AN所在侧血管及选用合适的弹簧圈;为早期GDC栓塞治疗提供确切依据和指导信息。

The clinical value of three-dimensional computed tomographic angiography in embolization of acutely ruptured intracranial aneurysms with Guglielmi detachable coil

Objective To evaluate the clinical value of three dimensional computed tomographic angiography (3D CTA) in embolization of ruptured intracranial aneurysms with Guglielmi detachable coil (GDC). Methods From December 1998 to February 2002, 175 consecutive patients with acute subarachnoid hemorrhage (SAH) underwent 3D CTA on the day of admission. All the patients with intracranial aneurysms diagnosed by 3D CTA received emergentcy intraaneurysmal GDC embolization in case the ruptured aneurysm was suitable to endovascular therapy. Results Eighty patients with intracranial aneurysms received successfully emergency GDC embolization according to the results of 3D CTA, all verified by digital subtraction angiography (DSA). 3D CTA was superior to DSA in depiction of the 3D anatomy of aneurysms and parent arteries and provided valuable information for embolization of intracranial aneurysms prior to catheter angiography, especially for anterior communicating artery aneurysms. Conclusion 3D CTA discloses the existence of intracranial aneurysms early, establishes the indications of embolization prior to the catheter angiography, determines the side of insertion of guiding catheters, helps choose the appropriate coil size, and may become a routine diagnostic modality.