颅内动脉瘤栓塞后载瘤动脉缺血治疗的临床分析

目的：探讨颅内动脉瘤电解可脱卸弹簧圈(GDC)血管内栓塞术后载瘤动脉缺血的l临床治疗及相关影响因素。方法：选择颅内动脉瘤经血管内GDC栓塞治疗病例41例，术后7例出现载瘤动脉闭塞。就其相关因素，治疗方法、临床结果进行分析、探讨。结果：颅内动脉瘤Hunt-Hess分级1～3级41例病例中，经血管内GDC栓塞治疗后，7例出现载瘤动脉主干或其分支闭塞缺血所造成相应的临床神经症状，头疼、头昏、偏瘫、失语、偏盲及出血；经过三高(高血压、高血容量和高血稀释度)、抗痉挛、腰穿等综合治疗后，5例恢复良好，2例遗留偏瘫。结论：颅内动脉瘤栓塞后出现载瘤动脉主干狭窄或闭塞是其易发并发症之一，术中动态观察载瘤动脉血供情况，了解栓塞程度是预防其发生的手段之一，出现狭窄或闭塞时，要及时调整GDC和微导管，并给以抗痉挛、抗凝、扩血管以及三高治疗，当出现恶性颅高压症时手术配合治疗，往往会取得较好的临床效果。

Clinical analysis of treatment for cerebral arterial ischemia after GDC embolization

Objective To discuss treatmenr for cerebral arterial ischemia of intracranial aneurysmswith GDCs treatment and its' related factors. Methods Seven cases with occlusion of parent arteries and its branches after GDCs treatment for 41 cases, (Hunt-Hess score were in 1-3 level) showed clinical symptoms as headache, dizzines, hemiplegia, logagnosia, hemianopia and haemorrhagia. Conservative treatments were undertaken as 3H management, combining with antispasmodic, anticoagulant and lumbar puncture treatment. Results Five cases recovered fully, 2 cases with hemiplegia outcoming with one recovery within 3 weeks and another of permanent hemiplegia. Conclusions Cerebral ischemia is a common complication of GDC procedure. Proper management of the degree of cerebral arterial emphraxis of stenosis, should be the key point for preventing and treating cerebral ischemia