颅内宽颈动脉瘤介入治疗的临床研究

Department of Interventional Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011,China

关键词:  颅内动脉瘤  栓塞  支架  球囊

Key words:  intracranial aneurysm  embolization  stent  balloon

摘要:

目的　分析颅内宽颈动脉瘤介入治疗的疗效及随访结果。方法　对58例（60枚）颅内宽颈动脉瘤患者行介入栓塞治疗。其中，45例（46枚）患者行支架辅助下动脉瘤栓塞术，12例（13枚）行球囊辅助下栓塞，1例应用双微导管技术栓塞。并随访2～60个月，应用改良Rankin评分（mRS）进行评价。21例患者行动脉造影或MRA随访。结果　术后即刻栓塞程度：0级栓塞14个，1级栓塞29个，2级栓塞15个，3级栓塞2个。手术相关并发症8例，其中5例为血栓栓塞并发症（4例为支架辅助栓塞，1例为球囊辅助栓塞）。平均随访13.9个月，mRS 0分42例，1分8例，2分3例，3分2例，4分2例，5分1例。3例复发，2例再次栓塞治疗。结论　颅内宽颈动脉瘤的介入栓塞是安全有效的治疗方法，血栓栓塞事件是主要并发症，主要见于支架辅助栓塞病例，抗血小板凝集不充分是血栓栓塞事件的主要原因。

Abstract:

Objective 〖WTBZ〗To analyze the efficacy of endovascular coil embolization for intracranial wide-necked aneurysms and follow-up results. 〖WTHZ〗Methods 〖WTBZ〗Fifty-eight patients with wide-necked aneurysms were treated with multiple endovascular strategies. 46 intracranial wide-necked aneurysms (45 patients) were treated with stent-assisted coil embolization, 13 (12 patients) with balloon-assisted embolization, and 1 with double microcatheter technique embolization. Immediate postprocedural and follow-up results were evaluated. The main outcome was measured with modified Rankin scale. DSA or MRA were used for imaging follow-up. 〖WTHZ〗Results 〖WTBZ〗Grade 0 aneurysm occlusion was achieved in 14 aneurysms, Grade 1 in 29 aneurysms, Grade 2 in 15 aneurysms, Grade 3 in 2 aneurysms. 5 suffered procedure-related thromboembolic events. After a mean follow-up of 13.9 months, modified Rankin Scale was 0 in 42 cases, 1 in 8 cases, 2 in 3 cases, 3 in 2 cases, 4 in 2 cases and 5 in 1 case. 2 aneurysms were retreated because of recurrence. 〖WTHZ〗Conclusion 〖WTBZ〗Endovascular embolization can be performed safely and effectively in intracranial wide-necked aneurysms. Thromboembolic events are the main compications during or after procedure, with inadequate antiplatelet the main reason.