破裂颅内动脉瘤急诊介入栓塞治疗189例临床分析

目的 探讨应用血管内介入栓塞技术治疗急性期颅内破裂动脉瘤的临床疗效.方法 对以蛛网膜下腔出血（SAH）为首发症状的侣9例（198个）颅内动脉瘤早期（出血后3d内）采用血管内介入栓塞治疗.患者术前Hunt-Hess分级l-II级105例,m级48例,Ⅳ级34例,Ⅴ级2例;均采用电解或水解脱式微弹簧圈栓塞治疗,其中32例宽颈动脉瘤采用球囊瘤颈成型弹簧圈栓塞术,16例宽颈或者梭形动脉瘤采用支架辅助弹簧圈栓塞术.1例假性动脉瘤单纯采用带膜支架植入闭塞,1例载瘤动脉单纯采用球囊闭塞,2例动脉瘤采用胶水或者胶水加弹簧圈栓塞.结果 198个颅内动脉瘤完全致密栓塞166个,不完全致密栓塞21个,不完全栓塞10个,栓塞失败1个;术中发生出血6例.术后发生再出血2例,死亡3例.结论 对Hunt-Hess分级Ⅰ～Ⅳ级的患者实施急诊介入治疗安全可靠,可避免动脉瘤再次破裂出血,防止或减少并发症,明显降病死率和致残率.

Evaluation of ruptured intracranial aneurysm treated by emergency endovascular interventional therapy

Objective To explore the clinical value of endovascular interventional treatment for the patients with ruptured intracranial aneurysm. Methods Retrospectively analyzed the clinical data of 189 patients with ruptured intracranial aneurysm diagnosed by digital subtraction angiography （DSA）. All the patients treated by interventional therapy under general anesthesia within 72 hours from SAH. Preoperative Hunt-Hess grade ： 105 cases were Ⅰ - Ⅱ, 48 cases were Ⅲ, 34 cases were Ⅳand 2 case was V. Results 105 patients with 198 intracranial aneurysm, Angiography showed complete occlusion in 166 aneurysm, 90% occlusion in 21 aneurysm, 50% - 60% embolization in 10 aneurysm, and 1 aneurysm was failed during the procedure. 6 a- neurysm was ruptured during the procedure,2 aneurysm was ruptured after the operation,3 cases were dead.Conclusion The treatment for the patients from SAH I - IV grade in ultra early period can avoid rebleeding from aneurysms, decreased the ratio of vasospasm and mortality and has the advantaae of mini-invasive and lower complications.