远侧大脑前动脉动脉瘤的血管内栓塞治疗

目的探讨远侧大脑前动脉动脉瘤的临床与影像学特征及其血管内栓塞治疗的安全性与疗效。方法回顾性分析29例远侧大脑前动脉动脉瘤的血管内治疗经验。采用载瘤动脉闭塞3例，支架辅助弹簧圈栓塞2例，单纯瘤内弹簧圈栓塞23例，单纯弹簧圈治疗失败后改行开颅手术1例。结果28例血管内栓塞治疗获得成功。25例采用弹簧圈瘤内填塞病人中，致密栓塞22例（88．0％）．大部栓塞2例（8．0％），部分栓塞1例（4．0％）。术后死亡2例（6．9％），重残2例（6．9％），轻残2例（6．9％），余病人恢复良好。采用DSA随访14例，MRA随访5例；显示复发2例（10．5％），其中1例为术后3年发生再出血病例，行再次栓塞治疗。结论血管内栓塞治疗远侧大脑前动脉动脉瘤安全有效，但具有一定的复发率，需长期密切随访。

Endovascular embolization of distal anterior cerebral artery aneurysm

Objective To investigate the clinical and radiographic characteristics of distal anterior cerebral artery （DACA） aneurysms, and evaluate the efficacy and safety of endovascular treatment for DACA aneurysms. Methods Twenty-nine patients with DACA aneurysms treated by endovascular emholization were analyzed retrospectively. Parent artery occlusion was performed in 3 patients, stent-assisted coiling in 2, endosaccular coiling alone in 23, and 1 patient received craniotomy after failure of coil occlusion. Results Technical success was achieved in 28 patients. Among 25 patients treated by endosaccular coiling, complete occlusion was obtained in 22 patients （88.0%）, subtotal occlusion in 2 （8.0%）, and partial occlusion in 1 （4.0%）. Two patients died post-operation, 2 had severe disability （6.9%） and 2 light disability （6.9%）. Follow-up DSA in 14 patients and MRA in 5 showed that there was a recurrence in 2 cases and gave retreatment, one out of them developed rebleeding 3 years later. Conclusion Endovascular embolization for DACA aneurysms is safe and effective, however, the relatively high recurrence rate highlights long-term follow-up for its security.