相对宽颈的颅内破裂微小动脉瘤的血管内治疗

目的 探讨相对宽颈的颅内破裂微小动脉瘤(动脉瘤最长径≤3 mm且动脉瘤颈/瘤体宽径I>3/4)血管内治疗的町行性和安全性.方法 回顾分析24例27个相对宽颈的颅内破裂微小动脉瘤的临床、影像、血管内治疗和随访资料.结果 27个动脉瘤中24个用弹簧圈栓塞,3个仅在载瘤动脉内放置支架.前者有4个动脉瘤100%栓塞,13个90%,6个80%,1个80%以下.2例术后出现一过性轻偏瘫.所有患者临床随访平均51个月(1-94个月)无再出血,6例7个动脉瘤在术后6-38个月复查血管造影,未见再生长.结论 相对宽颈的颅内破裂微小动脉瘤的血管内治疗,技术上可行,操作相对安全,初步结果有效.

Endovascular treatment of ruptured very small intracranial aneurysms with relatively wide - neck

Objective To assess the feasibility and safety of endovascular treatment of ruptured very small intracranial aneurysms with relatively wide - neck( defined as ≤3 mm in maximum aneurysmal diameter and ≥3/4 in neck -to - dome ratio).Method Twenty-seven ruptured very small intracranial aneurysms with relatively wide necks were treated by endovascular procedures between Jan. 2002 and Oct 2009. Their clinical, angiographic, intervention and follow -up data were reviewed in this study. Results The mean age of 24 patients (9 males and 15 females) was 56. 3 years (range 27～83 years ) , and the Hunt - Hess grade was Grade I ～II in 16 patients and Grade M ~ IV in 8. All of the 27 aneurysms were not more than 3 mm in maximum diameter and not less than 3/4 in neck - to - dome ratio. The locations of 27 aneurysms were PCoA(7 aneurysms) ,AcoA(8) ,ICA(6) ,MCA(3) ,AChA( 1) ,pericallosal artery( 1) and VA( 1). Twenty - four of the 27 aneurysms were successfully occluded with 1 to 3 coils respectively and the total length of coil(s) packed in each aneurysm varied from 10 to 100 mm (mean 34.4 mm) .whereas the remaining 3 aneurysms were treated by sole stent deployment in the parent artery. Of the 24 coiled aneurysms, the occlusion rate was 100% in 4 aneurysms,90% in 13,80% in 6 and less than 80% in 1. Procedural complications occurred in 2 patients, both resulting in transient mild hemiparesis. All patients were clinically followed up for a mean time of 51 months (range 1-94 months) ,and there was no rebleeding. Angiographic follow - up of 7 aneurysms in 6 patients was performed at 6 - 38 months after the procedures, which demonstrated no evidence of aneurysmal re - growth. Conclusions For ruptured very small aneurysms with relatively wide - necks, endovascular therapy with coil embolization or stent placement in parent artery is technically feasible,relatively safe and seems to be effective in preventing rebleeding.