血管内栓塞治疗老年破裂性颅内动脉瘤

目的探讨老年患者破裂性颅内动脉瘤的临床特点和血管内治疗的方法。方法选择35例年龄≥60岁患者共39个颅内动脉瘤,全部经全脑血管造影明确诊断。对37个动脉瘤采用了血管内治疗,其中9例宽颈动脉瘤采用三维弹簧圈成篮技术、联合支架或球囊重构形技术;1例梭形动脉瘤患者,采用支架贴覆治疗;其余动脉瘤患者采用单纯栓塞治疗。结果对39个动脉瘤的37个成功实施血管内治疗术,成功率为94.9%;栓塞动脉瘤36个,一期达致密栓塞25个,占69.4%。35例患者中,术后良好23例,遗留不同程度的神经功能障碍9例,死亡3例。结论血管内治疗是老年破裂性颅内动脉瘤患者首选的治疗方法 ,但对患者相关慢性疾病的处理和术后血管痉挛的治疗,应给予足够重视。

Endovascular embolotherapy for elderly patients with ruptured intracranial aneurysm

Objective To summarize the clinical characteristics and endovascular treatment of ruptured intracranial aneurysms in elderly patients.Methods Thirty-nine intracranial aneurysms in 35 patients older than 60 years were diagnosed by cerebral angiography,and 37 of the 39 aneurysms were treated with endovascular therapy.The 9 wide necked aneurysms were embolized by different technical procedures,such as basket technique with 3D coils,balloon remodeling and stent assistant remodeling techniques,and 1 patient diagnosed to have fusiform aneurysm was treated with stent cover only.The other patients were treated with embolization by coils merely. Results Thirty-seven of 39 aneurysms were treated successfully(94.9%).Of the 36 embolized aneurysms,25 achieved compact embolization(69.4%).Among the 35 patients,except 1 case received clipping,23 patients were evaluated to have good postoperative results,9 cases retained nerve function disorders of various degrees,and 3 cases died.Conclusion Endovascular embolotherapy is the first choice of therapy for the aged patients with ruptured intracranial aneurysms. However,the treatment for the related chronic illness and postoperative angiospasm is very important and sufficient attention should be paid to them.