血管内治疗低级别破裂前交通动脉动脉瘤合并颅内血肿的临床分析

目的探讨血管内治疗低级别(Hunt-Hess分级Ⅰ~Ⅲ级)破裂前交通动脉(ACoA)动脉瘤合并颅内血肿的安全性及有效性。方法回顾性分析2015年3月至2020年3月于南京医科大学第一附属医院介入放射科接受血管内治疗的42例低级别ACoA动脉瘤合并颅内血肿患者的临床及影像学资料。42例ACoA动脉瘤采用单纯弹簧圈栓塞32例,支架辅助弹簧圈栓塞10例;颅内血肿均采取保守治疗。术后影像学随访采用数字减影血管造影(DSA)或CT血管成像,并采用Raymond分级标准评估动脉瘤的栓塞程度;临床随访采用格拉斯哥预后评级(GOS)(出院时)和改良Rankin量表评分(mRS)评估(6个月时)。结果42例ACoA动脉瘤栓塞术后即刻DSA显示,动脉瘤完全闭塞(RaymondⅠ级)21例(50.0%),近全闭塞(RaymondⅡ级)20例(47.6%),部分闭塞(RaymondⅢ级)1例(2.4%)。总体并发症的发生率为9.5%(4/42),包括1例支架辅助术后血栓栓塞性事件及3例迟发性脑缺血事件。术后复查头颅CT显示血肿均较前吸收,出院时GOSⅤ级34例(80.9%),Ⅳ级7例(16.7%),Ⅲ级1例(2.4%),无死亡患者。42例患者中,36例(85.7%)接受DSA复查,复查的中位时间为6.5个月(4~12个月),其中RaymondⅠ级32例(88.9%),Ⅱ级4例(11.1%)。1例动脉瘤复发,予以支架辅助弹簧圈再次栓塞治疗。术后6个月的临床随访显示,患者的预后良好(mRS 0~2分)率为97.6%(41/42)。结论血管内治疗低级别ACoA动脉瘤合并颅内血肿安全有效,支架辅助栓塞并未增加并发症的发生风险,血肿经过栓塞后可吸收,但需大样本数据及长期随访进一步证实。

Clinical analysis of endovascular treatment for low-grade ruptured anterior communicating artery aneurysms complicated with intracranial hematomas

Objective To evaluate the safety and efficacy of endovascular treatment in patients with low-grade(Hunt-Hess gradeⅠ-Ⅲ)ruptured anterior communicating artery(ACoA)aneurysms complicated with intracranial hematomas.Methods The clinical and imaging data of 42 patients with low-grade ACoA aneurysm combined with intracranial hematomas who underwent endovascular treatment at the Interventional Radiology Department of the First Affiliated Hospital of Nanjing Medical University from March 2015 to March 2020 were retrospectively analyzed.Among 42 cases of ACoA aneurysms,32 cases underwent simple coil embolization and 10 cases underwent stent-assisted embolization.Intracranial hematomas were treated conservatively.Digital subtraction angiography(DSA)or CT angiography(CTA)was used for postoperative imaging follow-up,and Raymond classification was used to evaluate the embolization effect of aneurysm.For clinical follow-up,we used Glasgow Outcome Scale(GOS)(at discharge)and modified Rankin scale(mRS)(at 6 months).Results For 42 cases of ACoA aneurysm,immediate DSA post embolization showed complete occlusion(RaymondⅠ)in 21 cases(50.0%),near-complete occlusion(RaymondⅡ)in 20 cases(47.6%),and partial occlusion(RaymondⅢ)in 1 case(2.4%).The overall complication rate was 9.5%(4/42),including 1 case of stent-assisted postoperative thromboembolic event and 3 cases of delayed cerebral ischemia.Postoperative reexamination of the head CT showed absorption of hematoma compared with preoperative conditions.At the time of discharge from the hospital,there were 34 cases of GOS gradeⅤ(80.9%),7 cases of gradeⅣ(16.7%),and 1 case of gradeⅢ(2.4%).There was no death.Among 42 patients,36 patients(85.7%)underwent DSA review,and the median time for review was 6.5 months(4-12 months).Among them,32 patients(88.9%)were in Raymond GradeⅠand 4 patients were in GradeⅡ(11.1%).One case of aneurysm recurrence was treated with stent-assisted re-embolization.Clinical follow-up at 6 months after surgery showed that the patient's favorable prognosis(mRS of 0-2 points)rate was 97.6%(41/42).Conclusions Endovascular treatment for low-grade ACoA aneurysms with hematomas is safe and effective,and stent-assisted coiling embolization does not significantly increase the risk of complications.The hematoma can be absorbed after aneurysm embolization.However,those need to be further confirmed by large sample data and long-term follow-up.