栓塞治疗脑动脉瘤术中并发症的原因分析与防治

目的：探讨颅内脑动脉瘤血管内栓塞治疗术中并发症发生的原因，提高脑动脉瘤栓塞治疗的成功率。方法：自2002年9月至2008年10月，弹簧圈栓塞治疗颅内动脉瘤276例。其中，电解弹簧圈（GDC、EDC）栓塞122例，水解弹簧圈（Mi—croPlex、HydroCoil）栓塞110俐，两种弹簧固混合栓塞44例。相对宽颈动脉瘤采用双傲导管技术栓塞4例，球囊辅助（Remodeling）技术栓塞12例。结果：术中发生并发症12例，其中动脉瘤破裂出血6例，血栓形成2例，弹簧圈脱出2例，严重脑血管痉挛2例。影像上致密栓塞226例，栓塞90％以上38例，栓塞80％以上12例。12例并发症患者中2例轻度瘫痪，1俐重残，2例死亡。结论：CTA结合DSA可增加硕内脑动脉瘤的检出率，有助于制定介入栓塞治疗的策略。规范操作可大大减少术中并发症的发生，提高脑动脉瘤栓塞治疗的成功率。

CAUSAL ANALYSIS ,PRERENTION AND TREATMENT OF COMPLICATIONS AFTER ENDOVASCULAR EMBOLIZATION TREATMENT OF INTRACRANIAL ANEURYSMS

Objective：To explore the causes of complications after endovascular embolization treatment of intracranial aneurysms and improve the success rate of the treatment. Methods：From September 2002 to October 2008, 276 cases were treated by endovaseular embolization. 122 aneurysms used CDC/EDC, 110 aneurysms used Microplex/Hydrocoil and 44 cases used mixed embolization. Among the 16 wide-necked aneurysms, 4 cases used double micro-catheter embolization technique and 12 cases used balloon assisting device. Results：The associated complications occurred in 12 patients. Re-rupture Of aneurysm during the operation in 6 patients, thrombosis formation in 2 patients, microcoil terminal escaped in postoperation in 2 cases, severe cerebral angiospasm in 2 patients. Complete embolization was achieved in 226 cases, near complete embolization（〉90%）was achieved in 38 aneurysms, and partial embolization （80%-90%）in 12 aneurysms. Of the complications group （12 cases）, 2 cases were mild paralysis, 1 case with serious deformity and 2 cases dead. Conclusion：DSA combined CTA can increase the detection rate of intracranial aneurysms and contribute to the development of interventional treatment strategy.Standardized operation can greatly reduce the occurrence of intraoperative complications and improve the success rate of the treatment.