动脉瘤性蛛网膜下腔出血患者在血管内弹簧圈治疗中动脉瘤破裂的原因、处理和预后  

Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: cause,management and prognosis

作　　者：聂志余[1] 黄冬雅[1] 陈左权[1] Matin Schumacher 

机构地区：[1]同济大学脑血管疾病治疗中心 [2]Sec-tion of Neuroradiology University Hospital,Freiburg,Germany79016

出　　处：《中风与神经疾病杂志》2005年第3期227-229,i001,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(SAH)患者在血管内弹簧圈治疗中动脉瘤被穿破的原因、处理和预后。方法回顾性研究1992～2003年在弗莱堡大学医院神经中心的202例急性动脉瘤性SAH接受血管内弹簧圈介入治疗患者,系统研究病例记录和由2名神经放射科医生重新阅片。结果6例患者发生介入术中动脉瘤被穿破,男1例,女5例,年龄33～87岁。5例囊性动脉瘤,1例右颈内动脉夹层动脉瘤。4例被弹簧圈穿破,1例被微导丝穿破,1例被微导管穿破。4例临床预后好,出院时没有新的神经功能缺损(mRS0分和2分各2例),1例临床状况无改变(治疗前H&HV级,出院时mRS5分),1例死于严重的SAH(治疗前H&HV级)。结论在动脉瘤性SAH患者的血管内弹簧圈治疗中,总的术中穿破率为3%,死亡率为0.5%;造影剂外渗或弹簧圈的头端突出动脉瘤外提示术中动脉瘤被穿破,发生穿破后应尽可能快的用弹簧圈封堵动脉瘤的破裂部位;患者的预后可能与治疗前病情轻重直接相关。Objective The aim of this study was to assess retrospectively the incidence,management and outcome of procedure-related rupture of intracranial aneurysms in patients treated with Guglielmi detachable coils (GDCs). Methods A retrospective analysis was conducted in 202 patients with aneurysmal subarachnoid hemorrhage treated with Guglielmi detachable coils in neurocenter,Freiburg University from 1992 to 2003. Patients' medical records were systematically examined and angiograms were reviewed by two neuroradiologists. Results Of 202 patients with recently ruptured intracranial aneurysms treated with coil embolization,six (3%) had an intraprocedural rupture. Of these six,5 were women and 1 was man. The mean age was 52.5 years old(ranging between 33～87y). 5 aneurysms were saccular and 1 was right internal carotid artery dissecting aneurysm. Aneurysmal rupture resulted from detachment of the coil in 4 patients. In 1 patient,the aneurysmal rupture was a result of catheter advancement before detachment of the coil. Aneurysm was perforated by microguidewire in the last patient. mRS (modified Rankin Scale) at discharge was 0 in two patients,2 in two patients,5 in one patient and 6 in another one patient. Conclusion The rate of aneurysm rupture during coil embolization is 3% and is responsible for 0.5% of treatment-related deaths. If extravasation of contrast agent or the tip of coils outside of the aneurysm were seen,which suggests intraprocedural rupture,further coil deposition should be attempted as quickly as possible. The clinical outcome may be related to the patient condition before coiling treatment.

关 键 词：蛛网膜下腔出血 动脉瘤 血管内治疗 弹簧圈 破裂 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R739.41[医药卫生—临床医学]