GDC栓塞术中颅内动脉瘤再破裂的原因、对策与结果

目的探讨电解脱弹簧圈(Guglialm i detachab le coil,GDC)颅内动脉瘤栓塞术中动脉瘤再破裂的发生率、原因、对策及结果。方法302例颅内动脉瘤破裂患者行GDC栓塞术,其中8例发生术中动脉瘤再破裂。结果2例由微导丝穿破动脉瘤壁引起,3例由微导管穿破动脉瘤壁引起,2例由置放首枚弹簧圈时顶破动脉瘤壁引起,l例术中自发破裂,所有病例均继续行GDC动脉瘤填塞。2例死于动脉瘤破裂后大出血,其他6例均康复没有留下后遗症。本组术中动脉瘤再破裂发生率为2.6%,死亡率为25%。结论GDC血管内栓塞术中引起动脉瘤再破裂是十分少见的,但大部分病例经过继续填塞GDC可达到完全填塞动脉瘤,且不留下后遗症。

Aneurysmal Rupture during Embolization with GDC: Causes, Management, and Outcome

Objective To study the frequency, causes,management,and outcome of aneurysmal rupture that occurred during treatment with Guglielmi detachable coil(GDC) embolization.Methods We treated 302 ruptured cerebral aneurysms with GDC embolization.The rupture during procedure in 8 cases.Results In two patients,rupture was due to guidewire perforation of the wall.In three patients,the microcatheter perforated the aneurysm.In two patients with re-rupture related to coils.In one patient with re-rupture related to itself.Endovascular parking with GDC continued in all patients.Two patients died as a result of intracerebral over-blooding.No negative long-term effects were observed in the remaining six patients.We observed intraprocedural aneurysmal rupture in 2.6% of our patients,with a mortaliy rate of 25%.Conclusion Aneurysmal rupture during endovascular treatment with GDC is a rare event;A continuous parking with GDC is possible to get a total occlusion without any sequels in most cases.