破裂颅内微小动脉瘤介入栓塞技术探讨Endovascular treatment of ruptured intracranial very small aneurysms
徐浩文,付振强,孙石磊
摘要(Abstract):
目的评估介入栓塞破裂颅内微小动脉瘤的疗效和安全,探讨介入栓塞此类动脉瘤的技术要点。方法回顾性分析2007-01~2010-11郑州大学第一附属医院22例微小动脉瘤破裂所致的蛛网膜下腔出血患者的临床、影像学结果和术中操作。所有患者均全麻下采用弹簧圈栓塞治疗(其中13例采用单纯弹簧栓塞,7例支架辅助,2例球囊辅助)。结果 22个动脉瘤中,致密栓塞17例,瘤颈残留1例,瘤腔残留4例,未出现弹簧圈移位和载瘤动脉血栓栓塞事件,术中出现动脉瘤破裂出血2例,术后一过性轻偏瘫1例,死亡1例。结论介入栓塞破裂颅内微小动脉瘤效果可靠;规范且熟练的操作,选择适合的手术方式和介入材料的合适是微小动脉瘤治疗成败的关键。
关键词(KeyWords): 微小动脉瘤;介入治疗;弹簧圈;栓塞
基金项目(Foundation):
作者(Author): 徐浩文,付振强,孙石磊
参考文献(References):
- [1]Molyneux AJ,Kerr RS,Yu LM,et al.International Sub-arachnoid Aneurysm Trial(ISAT)Collaborative Group.In-ternational subarachnoid aneurysmtrial(ISAT)of neurosur-gical clipping versus endovascular coilingin 2143 patients withrupturedintracranial aneurysms:a randomised comparison ofeffects on survival,dependency,seizures,rebleeding,sub-groups,and aneurysm occlusion[J].Lancet,2005,366:809-817.
- [2]Van Rooij WJ,Sluzewski M,Beute GN,et al.Proceduralcomplications of coiling of rupturedintracranial aneurysms:in-cidence and risk factors in a consecutive series of 681 patients[J].AJNR AmJ Neuroradiology,2006,27:1 498-1 501.
- [3]Jean Raymond,Fran?ois Guilbert,Alain Weill,et al.Long-Term Angiographic Recurrences After Selective EndovascularTreat ment of Aneurysms With Detachable Coils[J].Stroke,2003;,34:1 398-1 403.
- [4]Toshihiro Ishibashi,Yuichi Murayama,Mitsuyoshi Urashi ma,et al.UnrupturedIntracranial Aneurysms Incidence of Ruptureand Risk Factors[J].Stroke,2009,40:313-316.
- [5]Wiebers DO,Whisnant JP,Huston J,et al.InternationalStudy of Unruptured Intracranial Aneurysms Investigators.Unruptured intracranial aneurysms:natural history,clinicaloutcome,and risks of surgical and endovascular treat ment[J].Lancet,2003,362:103-110.
- [6]Roos EJ,Rinkel GJ,Velthuis BK,et al.The relation betweenaneurysmsize and outcome in patients with subarachnoid hem-orrhage[J].Neurology,2000,54:2 334-2 336.
- [7]Taylor CL,Steele D,Kopitnik TA Jr,et al.Outcome aftersubarachnoid hemorrhage froma very small aneurysm:a case-control series[J].J Neurosurg,2004,100:623-625.
- [8]Salary M,Quigley MR,Wilberger JE.Relation among aneu-rysmsize,amount of subarachnoid blood,and clinical outcome[J].J Neurosurg,2007,107:13-17.
- [9]Nguyen TN,Raymond J,Guibert F,et al.Association of en-dovascular therapy of very small ruptured aneurysms withhigher rates of procedure-related rupture[J].J Neurosurgury,2008,108:1 088-1 092.
- [10]Brisman JL,Nii mi Y,Song JK,et al.Aneurysmal ruptureduring coiling:lowincidence and good outcomes at a singlelarge volume center[J].Neurosurgery,2005,57:1 103-1108.
- [11]Schuette AJ,Hui FK,Spiotta AM,et al.Endovascular ther-apy of very small aneurysms of the anterior communicating ar-tery:five-fold increased incidence of rupture[J].Neurosur-gery,2011,68:731-737.