血管内栓塞治疗颅内破裂微小动脉瘤的疗效分析

目的探讨血管内栓塞治疗颅内破裂微小动脉瘤(瘤体最大径≤3mm)的方法和疗效。方法回顾性分析2006年1月—2011年12月,45例(45个)颅内破裂微小动脉瘤患者血管内栓塞治疗的资料。动脉瘤位于前交通动脉29例,后交通动脉11例,大脑前动脉A1段3例,小脑下后动脉2例。其中单纯采用弹簧圈栓塞治疗28例,血管内支架置入联合弹簧圈栓塞治疗8例,球囊辅助技术栓塞4例,双微导管技术栓塞3例,单纯血管内支架置入2例。结果①动脉瘤达到致密栓塞28例,大部分填塞15例,单纯支架成功置入2例。②术中并发症情况:1例发生术中出血,经继续填塞弹簧圈后,术后恢复良好。1例前交通动脉动脉瘤术中发生同侧大脑中动脉急性血栓形成,经溶栓后再通,但术后头部CT显示有皮质梗死,患者遗有左侧肢体偏瘫。对5例脑室积血患者行脑室外引流。③出院时改良Rankin评分:0～1分28例,2分14例,3～4分2例,5分1例。④DSA随访24例患者,随访时间6～12个月,无一例复发;CT血管成像随访12例,随访时间为2～6年,未见复发。结论血管内栓塞是治疗颅内破裂微小动脉瘤的有效方法,精确的微导管塑形,合适的弹簧圈选择,个性化的治疗方案和减少并发症是保证疗效的关键。

Efficacy analysis of endovascular embolization treatment of ruptured intracranial tiny aneurysms

Objective To investigate the methods and efficacy of endovascular embolization treat- ment of ruptured intracranial tiny aneurysms （ maximum diameter ≤ 3 mm）. Methods The data of 45 patients with ruptured intracranial tiny aneurysms （45 aneurysms） were analyzed retrospectively from Janu- ary 2006 to December 2011. Eleven aneurysms were at the posterior communicating arteries, 29 were at the anterior communicating arteries, 3 were at the A1 segment of the anterior cerebral arteries, and 2 were at the posterior inferior cerebellar arteries. Twenty-eight patients were embolized with coils only, 8 were trea- ted with endovascular stenting and coil embolization, 4 were embolized with balloon-assisted technique, 3 were embolized with double-microcatheter technique, and 2 were treated with endovascular stenting only. Results （~） 28 patients were achieved dense embolization, 15 were achieved partial embolization, and 2 had successful stent implantation. （~） Intraoperative complications： 1 patient experienced intraoperative bleeding. After continuous dense embolization with coils, the patient recovered well postoperatively. One patient had acute thrombosis of the ipsilateral middle cerebral artery during embolization of anterior commu- nicating artery aneurysm, and it was reeanalized after thrombosis. However, head CT showed cortex infarc- tion after the procedure, and he was left hemiplegia. External ventricular drainage was performed in 5 pa- tients with ventricular hematocele. （3） The modified Rankin scale （mRS） scores at discharge： 0 -1 in 28 cases, 2 in 14 cases, 3 -4 in 2 cases, and 5 in 1 case. （4） 24 patients were followed up with DSA at 6 to 12 months, and none of them had recurrence. The longest follow-up time in 1 case was 6 years. No recur- rence was observed with CT angiography. Conclusion Endovascular embolization is an effective method in the treatment of ruptured intracranial tiny aneurysms. Precise micro-catheter shaping, appropriate coil selection, personalized treatment programs, and reducing complications are the keys to ensuring the efficacy.