电解式可脱弹簧圈栓塞颅内动脉瘤的并发症及防治

目的 总结电解式可脱弹簧圈（GDC）栓塞颅内动脉瘤的并发症及防治经验。方法 用GDC栓塞动脉瘤108例，有20例出现24例次并发症，对其发生的原因及防治方法进行回顾性分析。结果 并发症中，动脉瘤破裂10例次，过度栓塞5例次，弹簧圈脱出动脉瘤5例次，血栓形成4例次，动脉瘤破裂后立即中和肝素，并力争继续栓塞止血，10例中死亡4例、重度残疾1例、轻度残疾1例，其余4例恢复正常。采用扩血管、溶栓、抗凝和升压等处理对过度栓塞、弹簧圈脱出和血栓形成进行治疗，5例过度栓塞中死亡1例、4例恢复正常；弹簧圈脱出动脉瘤5例中重度残疾1例、轻度残疾1例、其余无后遗症，血栓形成4例中死亡1例、遗有感觉性失语1例，余2例恢复正常。本组死亡5例(4.6%)，永久性神经功能缺失4例。结论 正确处理术中并发症、深刻理解动脉瘤和载瘤动脉的解剖形态特点、提高栓塞技术有 地减少并发症、提高治愈率。

Prevention and management of the complications during embolizing intracranial aneurysm with GDC

Objective To sum up the experience of embolization of intracranial aneurysm with Guglielmi detachable coil (GDC) and to discuss how to prevent and manage the complications during the endovascular treatment. Methods 108 patients with intracranial aneurysm were embolized with GDC. 24 accidents out of 20 patients during embolization were reviewed. Results Among the 24 accidents, there were 10 aneurysm rupture, 5 over embolization 5 coils end protrudings to parent artery, and 4 thrombosis. Once the aneurysm ruptures, neutralizing heparin and continuing embolization was administered. Among 10 cases of aneurysm ruptures, 4 were death, 1 was severe deformity, 1 was mild deformity. Thrombolysis, heparinization and raising blood pressure were used to control over embolization, coil protrusion, and thrombosis. Among 5 cases of over embolization, 1 died, 4 recovered. Among 5 cases of coils end protrudings, 1 was severe deformity, 1 was mild deformity . Among 4 cases of embolization, 1 died, 1 was led sensory aphasis. The accidents resulted in 5 deaths (4.6%), 4 permanent neurological deficits (3.7%). Conclusion The correct management of the complications during the treatment, the better understanding of the aneurysm and its parent artery angioanatomy and the improved skill of embolizing technique are helpful to reduce the accidents and increase the cure rate.