前交通动脉瘤的栓塞治疗

目的　总结 2 62例前交通动脉瘤栓塞治疗的经验。方法　均采用电解可脱卸弹簧圈(guglielmidetachablecoil,GDC)作动脉瘤内栓塞治疗。对双侧A1正常者应用双侧颈动脉置管技术监测栓塞术中载瘤动脉通畅情况 ,对瘤颈累及双侧A2者采用微导管微导丝辅助技术保持载瘤动脉通畅。发生术中出血者予弹簧圈继续栓塞 ,发生术中血栓形成者予尿激酶溶栓。 3 4例颅内多发动脉瘤均同次手术治愈。结果　动脉瘤完全闭塞 160例 ,>90 %闭塞 5 6例 ,<90 %闭塞 4 6例。术中因过度栓塞造成载瘤动脉闭塞 10例 ,术后脑梗死 16例。术中发生血栓形成 3例 ,经溶栓后恢复通畅。术后死于肺部并发症 1例 ,植物生存 1例。随访 190例 ,3～ 6个月行DSA/MRA复查 ,动脉瘤复发行 2次栓塞 8例 ,复发经手术治愈 1例 ,其余治疗结果稳定。结论　GDC栓塞治疗前交通动脉瘤效果好。采用微导管 /微导丝辅助技术可提高致密栓塞率和减少脑梗死并发症发生

Treatment of anterior communicating artery aneurysms with Guglielmi detachable coils

Objective To summarize the experience on endovascular treatment of anterior communicating artery aneurysms with Guglielmi detachable coils (GDCs) in 262 cases. Methods All aneurysms were embolized with GDCs. Catheterization at both ICA was used to monitor the patency of parent arteries for patients with well developed A1 segment of both ACAs. Microcatheter assisted or microwire assisted technique was undertaken to keep patency of parent arteries if the aneurysmal neck was involved with A2 segment. Tirty four cases with multiple aneurysms had been treated successfully only in one session. Results Complete embolization was achieved in 160 cases, while subtotal in 56 (>90%) and partial in 46 (<90%). Occlusion of parent arteries developed in 10 cases because of over occlusion, and cerebral infarction was found in 16 cases after the procedure. Three cases with procedure related thrombosis were revascularized by urokinase profusion. Follow up angiograms of 3 6 months showed recanalization in 8 cases requiring a second time session. One case of recurrent aneurysm after GDC treatment was cured by surgical clipping. Conclusions The result of endovascular treatment of anterior communicating artery aneurysms is fruitful and seems to be an alternative method in improving the rate of occlusion and reducing the cerebral infarction.