颅内动脉瘤的介入治疗

目的 :应用电解可脱式弹簧圈 (GDC)经血管内栓塞治疗颅内动脉瘤 ,探讨其临床疗效及相关问题 ,同时对旋转 DSA技术在颅内动脉瘤介入治疗中的临床价值进行评价。方法 :1 8例 2 0个颅内动脉瘤均采用 GDC血管内栓塞治疗 ,在术前分别行 DSA及旋转 DSA检查 ,同时对两种检查方式进行对照 ,并将旋转 DSA的最佳工作图像应用于手术中。结果 :本组无 1例死亡。 2 0个动脉瘤中 1 8个 (90 % )完全栓塞 ,2个 (1 0 % )不全栓塞。 2 0个动脉瘤常规 DSA检查 :3个 (3 /2 0 )动脉瘤的形状、大小显示不清 ,7个 (7/2 0 )动脉瘤的瘤颈以及与载瘤动脉、周围血管的关系显示不清。而通过旋转 DSA检查 :2 0个动脉瘤形状、大小均清楚显示。1 9个 (1 9/2 0 )动脉瘤的瘤颈及周围血管解剖关系清楚显示 ,1个 (1 /2 0 )动脉瘤 (<3 mm)的瘤颈不能清楚显示。统计学处理结果表明 ,旋转DSA在显示动脉瘤的形态、大小及动脉瘤颈的清晰度方面均优于常规 DSA检查。结论 :旋转 DSA技术可更好、更准确地分析动脉瘤的构筑 ,特别是瘤颈 ,有助于术者选择最佳角度的工作图像、合适直径的弹簧圈及恰当的治疗方案。使用 GDC血管内栓塞治疗颅内动脉瘤是一种安全有效的治疗手段

INTERVENTIONAL TREATMENT OF INTRACRANIAL ANEURYSMS

Objective: To investigate the clinical effects and relevant problems of the embolization of intracranial aneurysms by using GDC, and meanwhile, to assess the value of rotational DSA in the interventional therapy of intracranial aneurysms.Methods: 18 patients with 20 intracranial aneurysms received endovascular embolization with GDC. Conventional anteroposterior, lateral views of DSA and rotational DSA were respectively performed in 20 aneurysms before operation. Images were compared for shape and size of the aneurysm and visibility of the aneurismal neck, and meanwhile, an ideal working view from rotational DSA was used in endovascular treatment of aneurysms. Results: No mortality occurred in our group. In 20 embolized aneurysms, 18(90%) were totally occluded, 2(10%) were subtotally occluded. Among 20 aneurysms, conventional DSA examination could not clarify shape and size of 3(3/20) aneurysms, and the vascular branch including the aneurysmal neck could not be clarified in 7 (7/20) aneurysms . However, shape and size of 20 aneurysms could be clarified after using the rotational DSA, and meanwhile, visibility of the aneurysmal neck and vascular branch could be identified with the rotational DSA in 19 aneurysms, and visibility of aneurysmal neck of 1(1/20) aneurysm could not be identified. Statistical analysis showed that rotational DSA provided better definition of the aneurysmal neck and greater clarity of aneurysms than did DSA. Conclusion: Rotational DSA often allows better visibility of vascular branch and aneurysmal neck, offering a ideal working view, the diameter of the first coil and correct plan for endovascular treatment. The endovascular embolization with GDC is a safe and effective method for treatment of the intracranial aneurysms.