颅内动脉瘤血管内栓塞治疗的临床分析

目的总结颅内动脉瘤血管内栓塞治疗技巧及结果。方法采用血管内栓塞治疗76例80个颅内动脉瘤。对23个宽颈动脉瘤采用瘤颈成形辅助技术栓塞治疗,其中球囊辅助成形术治疗动脉瘤4个,微导丝辅助瘤颈成形技术治疗5个,支架结合弹簧圈栓塞治疗14个。6个巨大动脉瘤5个用可脱性球囊闭塞载瘤动脉,1个用电解可脱性弹簧圈闭塞载瘤动脉。结果栓塞程度:致密栓塞48个(64.9%。48/74),90%以上栓塞11个(14.9%,11/74),疏松(90%以下)栓塞15个(20.3%,15/74)。术中动脉瘤破裂出血4例(5.3%,4/76),2例死亡。结论电解可脱性弹簧圈栓塞颅内动脉瘤具有微创、安全、效果可靠等优点。采用微导丝辅助瘤颈成形技术、瘤颈重塑形技术、血管内支架等方法,可以明显提高宽颈动脉瘤的致密栓塞率和减少脑梗死并发症发生。

Clinical Analysis of Endovascular Embolization of Intracranial Aneurysms

Objective To summarize the technique of endovascular embolization of intracranial aneurysms and its curative effect. Method The endovascular embolization was performed in 76 patients with 80 intracranial aneurysms. Of 23 wide neck aneurysms, 4 were treated by balloon-assisted remodeling of aneurysmal neck technique, 5 by microwire-assisted coiling technique and 14 by stenting combined with coils embolization. Of 6 giant aneurysms, 5 were treated by occluding parent arteries with detachable balloon, and 1 with Guglielmi detachable coils. Results Total occlusion of 48 aneurysms (64.9%, 48/74), more than 90% occlusion of 11 aneurysms (14.9%, 11/74), less than 90% occlusion of 15 aneurysms (20.3%, 15/74) were reached. Bleeding caused by aneurysm rupture occurred in 4 cases (5.3%, 4/76). Two patients died of aneurysm rupture. Conclusions It is suggested that embolization of intracranial aneurysms with detachable coils is minimally invasive, safe, effective and reliable. The techniques such as microwire-assisted coiling, remodeling of aneurysmal neck and stenting can enhance the total occlusion rate and decrease cerebral infarction rate in the patients with intracranial aneurysms.