血管内栓塞治疗破裂的前交通动脉瘤

目的探讨血管内栓塞治疗破裂的前交通动脉瘤的方法及并发症的防治。方法60例前交通动脉瘤采用水解、电解可脱性弹簧圈进行血管内栓塞。结果59例患者栓塞成功，1例因栓塞失败行手术夹闭。按GOS评分进行疗效评价，Ⅳ-Ⅴ级55例，Ⅲ级3例，Ⅰ级（死亡）2例。58例随访3～12个月均无再出血症状。55例行DSA或MRA检查，50例均未见动脉瘤再通，5例动脉瘤残腔未见增大。结论破裂的前交通动脉瘤栓塞术前应对动脉瘤进行充分评估。选择适当的弹簧圈进行填塞，术中适时造影，了解动脉瘤填塞情况及载瘤动脉的循环情况可避免血栓形成、动脉瘤再破裂等术中并发症的发生。血管内栓塞前交通动脉瘤的近、中期疗效是肯定的，但远期疗效还有待进一步观察。

Endovascular Embolization of Ruptured Aneurysms of Anterior Communicating Arteries with Detachable Coils(a Report of Cases)

Objective To explore the techniques of endovaseular embolization of ruptured intraeranial aneurysms of anterior communicating arteries （ACA）, and prevention and treatment of its complications. Method Sixty patients with aneurysms of ACA were treated by endovascular embolization with detachable coils. Results The aneurysmal cavities were successfully embolized in 59 patients, and the aneurysmal neck was microsurgically clipped in 1 patients after the endovascular embolization failed. According to GOS, the prognosis in 55 patients belonged in grades Ⅳ-Ⅴ, one in 3 belonged in grade Ⅲ, and one in 2 belonged in grade Ⅰ （died）. The following up from 3 to 12 months showed that bleeding did not recur in the 58 patients. DSA or MRA examination in 55 patients showed that there were no signs of aneurysmal recurrence in 50 patients and the residual aneurysmal cavities became not large in 5 patients. Conclusions Careful preoperative evaluation should be done for endovascular embolization of the ruptured intracranial aneurysm of ACA. Choice of the coils proper for aneurysm and timely evaluation of endovascular embolization state by DSA during endovascular embolization are important to prevent the complications including rerupture of aneurysm, thrombogenesis and so on. The short-term curative effect of endovascular embolization on the ruptured aneurysms of ACA is good, but its long-term effect should be further observed.