颅内破裂动脉瘤栓塞术后早期再次破裂原因分析

目的探讨颅内破裂动脉瘤急性期栓塞术后早期再次破裂的相关危险因素,以减少动脉瘤栓塞术后再次破裂的发生率,提高临床治疗效果。方法对689例颅内破裂动脉瘤患者(破裂动脉瘤689枚,未破裂动脉瘤25枚)于蛛网膜下腔出血后72h内进行血管内弹簧圈栓塞治疗。分析所有患者栓塞前后的影像学(包括头颅CT、TCD、DSA)和栓塞术后次日首次颅内压等资料。对所得数据进行Logistic回归分析,P<0.05为差异有统计学意义。结果所有接受栓塞治疗的患者中有6例发生早期再次破裂,占同期接受栓塞治疗患者的0.9%(6/689)。其中4例经CT证实,1例经持续腰池引流证实,另1例临床表现支持再次出血。栓塞后早期再次破裂出血的动脉瘤位于前交通动脉的4例,颈内动脉床突上段的2例。再次破裂患者中高颅压、高Fisher分级及循环时间延长者的比率远高于无再次破裂者。结论颅内破裂动脉瘤弹簧圈栓塞术后早期再次破裂的原因可能是:(1)栓塞不够致密;(2)栓塞当时显影的动脉瘤非真实大小。破裂后血管痉挛、颅高压、动脉瘤周围血肿等都可能是导致动脉瘤非真实显影的原因。栓塞术后早期复查DSA或进一步治疗可能会减少栓塞术后动脉瘤早期再次破裂的机会。

Analysis of the reasons for early re-ruptures of intracranial ruptured aneurysms embolized in acute phase

Objective To evaluate the probably risk factors correlated to the early stage re-rupture of intracranial aneurysms embolized in acute phase.Methods 689 consecutive patients(24-72 years old) with 689 ruptured and 25 un-ruptured intracranial aneurysms underwent coiling within 72 hours since SAH onset.All the patients,including whose aneurysms were re-ruptured in the early stage after coiling,were collected,and the neurological signs and symptoms before and after coiling were analyzed as well as the imageological material(including CT and DSA).Data were analyzed by Logistic regression.A value of P<0.05 was considered statistically significant.Results Six cases,accounting for 0.9%(6/689)of all the patients underwent coiling in the same phase,were found with re-ruptured aneurysms,among which four eases were validated by CT and one was validated by continued lumbar cistern drainage.The remained one was validated by clinical manifestation.There were four re-ruptured aneurysms located on the anterior communicating arteries and the other two in the superior segment of clinoid process.The ratios of high intracranial pressure,high Fisher grade and prolonged circulation time in the re-ruptured group were more than those in the non-re-ruptured one.Conclusions Our findings suggest that incompletely embolization of aneurysms and unreal visualization of aneurysms in acute phase were probably the main reasons for early stage re-rupture of aneurysms embolized in acute phase.Vasospasm,intracranial hypertension and hematoma of peri-aneurysms were probably the main reasons for unreal visualization of aneurysms in acute phase when angiography performed.Early re-examination by DSA and further treatment after first embolization may reduce the chance of re-rupture of intracranial aneurysms.