脑动静脉畸形供血动脉远端动脉瘤破裂栓塞治疗

目的 探讨脑动静脉畸形相关的供血动脉远端破裂动脉瘤的特点与血管内治疗方法.方法 11例以自发性蛛网膜下腔出血发病的患者均接受数字减影血管造影,并被证实出血来源于脑动静脉畸形供血动脉远端破裂动脉瘤.根据动脉瘤的形态和供血动脉特点,选择以弹簧圈闭塞动脉瘤和载瘤动脉,或以高浓度生物胶栓塞动脉瘤和载瘤动脉.结果 11例栓塞后的动脉瘤均消失,未发生再出血,以弹簧圈栓塞的7例术后未发生新的神经系统症状;以生物胶栓塞的4例有2例术后发生栓塞部位的脑梗死.结论 脑动静脉畸形供血动脉远端动脉瘤破裂后血管内栓塞治疗可取得较好的效果,首选以弹簧圈栓塞动脉瘤和载瘤动脉,也可用高浓度生物胶栓塞,动静脉畸形可择期再处理.

The embolization of distal ruptured aneurysms associated with arteriovenous malformation

Objective To discuss the character and appropriate endovascular therapy ways for the treatment of ruptured distal aneurysms associated with arteriovenous malformation (AVM). Methods 11 consecutive patients manifested with subarachnoid hemorrhage (SAH) underwent digital subtraction angiography (DSA), by whicheleven ruptured and five unruptured aneurysms were found. Coils or high density of glue were used to embolize the aneurysms themselves and part of the parent arteries according to the character of aneurysm and supplying artery. Results All of the distal ruptured aneurysms ( 11 ) and most of distal uuruptured aneurysms (3/4) were nonvisulization, and no SAH occurred from those aneurysms. One proximal and one distal unruptured aneurysm were left free for further following up. No more neurological deficiencies were found in the 7 patients treated by coils, and among the other 4 patients treated by glue, 2 patients were found with local infarction due to over diffusion of the glue. Conclusions Our findings suggest that distal ruptured aneurysms associated with AVM could be treated by coiling or embolized by glue with satisfied results. Coiling was recommended first to embolize the aneurysm as well as part of the parent artery. While embolizing with glue was alternative in certain condition. The unruptured AVM could be left alone for future treatment by gamma knife.