破裂与未破裂颅内微小动脉瘤的血管内治疗

目的 评价破裂与未破裂颅内微小动脉瘤(动脉瘤最长径≤3 mm)血管内治疗的可行性和安全性.方法 回顾分析2001年6月至2009年8月北京医院44例48个的颅内微小动脉瘤的临床、影像学、血管内治疗和随访资料.44例患者中,男20例,女24;平均年龄57.8岁;Hunt-Kosnik分级:0、1～2和3～4级的患者分别为11、23和9例,1例无法确定分级.48个动脉瘤中,动脉瘤瘤体最长径均≤3 mm;前交通、大脑中、后交通和颈内动脉动脉瘤依次分别为11、8、14和12个,胼周、椎和小脑后下动脉动脉瘤各1个.39个动脉瘤用弹簧圈行囊内栓塞(其中13个辅以支架,6个栓塞临时使用了球囊),9个动脉瘤仅在载瘤动脉内放置了支架.结果 39个囊内栓塞的动脉瘤中,9个动脉瘤100%栓塞,20个90%,9个80%,1个＜80%.术中破裂出血1例;术后一过性轻偏瘫2例,小脑梗塞致共济失调1例.对所有患者临床随访4～90个月无出血,13例在术后4～72个月复查血管造影,未见动脉瘤再生长.结论 破裂与未破裂的颅内微小动脉瘤的血管内治疗技术上可行,操作相对安全,初步结果有效.

Endovascular treatment of ruptured and unruptured intracranial very small aneurysms

Objective To evaluate the feasibility and safety of endovascular treatment of ruptured and unruptured intracranial very small aneurysms(≤3 mm in maximal diameter).Methods Forty-eight intracranial very small aneurysms in 44 patients treated with endovascular therapy from June 200l to August 2009 were reviewed retrospectively in clinical,imaging,interventional and follow-up data.Among 44 patients,there were 20 males and 24 females with a mean age of 57.8 years old.The Hunt-Kosnik grade Was as follows:Grade O(n=11);Grades Ⅰ& Ⅱ(n=23);Grades Ⅲ & Ⅳ(n=9);and ungraded(n=1).The sizes of 48 aneurysms were not more than 3 mm in maximal diameter.The locations of aneurysms were as follows:ACoA(n=11),MCA(n=8),PCoA(n=14),ICA(n=12),pericallosal artery(n=1),VA(n=1)and PICA(n=1).Thirty-nine aneurysms were embelized with coil,of which 13 with stent assistance and 6 by balloon remodeling technique.The other 9 aneurysms underwent sole stent placement in parent artery.Results Among 39 coiling aneurysms,100% occlusion wag achieved in 9 aneurysms,90% in 20.80% in 9 and less than 80% in 1 respectively.Only one aneurysm ruptured during coiling.Two patients had transient hemiparesis and one patient had ataxia caused by bilateral cerebellar infarction postoperatively.All patients were clinically followed up for 4-90 months and no recurrent hemorrhage occurred.Thirteen patients received repeat angiography at 4-72 months post-treatment.And no radiological re-growth Wag detected.Conclusion Endovascular treatment of ruptured and unruptured intracranial very small aneurysms seems to be technically feasible,relatively safe and practically effective.