颅内动脉瘤栓塞治疗后数字减影血管造影随访研究  

Digital subtraction angiography after intracranial aneurysm embolization:a follow-up study

作　　者：汪求精[1] 李铁林[1] 段传志[1] 陈光忠[1] 李学东[1] 郭元星[1] 方兵[1] 何旭英[1] 尹方明[1] 赵庆平[1] 徐如祥[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282

出　　处：《中国脑血管病杂志》2006年第3期100-105,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颅内动脉瘤栓塞术后再通、出血等问题及数字减影血管造影(DSA)随访的必要性。方法选择用GDC或EDC、MDS、Matrix微弹簧圈行血管内栓塞的颅内动脉瘤患者102例,共114个动脉瘤,112个动脉瘤行血管内栓塞,2例多发性动脉瘤患者各有1个小动脉瘤未行栓塞。随访时间为术后1个月至6．5年,平均10．5个月。随访方法为DSA,将随访时的DSA资料与栓塞术后即刻DSA资料进行对比分析。结果初始治疗的动脉瘤闭塞率为100%的58个(51．79%),≥95%的37个(33．04%),＜95%的17个(15．17%)。栓塞治疗后弹簧圈稳定的动脉瘤87个(77．68%),残腔体积缩小6个(5．36%),再通19个(16．96%)。采用GDC或EDC栓塞的90个动脉瘤中,14个再通(15．56%)。闭塞100%、≥95%和＜95%的动脉瘤,再通率分别为4．08%、26．67%和36．36%,三者之间差异有极显著性(P＜0．01)。对术后再通的动脉瘤,9个及时补充GDC栓塞后均未发生再出血,而继续观察的5个动脉瘤中,有1个不全闭塞者发生迟发性再出血。随访结果,经MDS栓塞治疗的18个动脉瘤中,5个再通。采用Ma- trix微弹簧圈或Neuroform支架+Matrix微弹簧圈治疗的4个动脉瘤,无论是近乎完全闭塞还是不完全闭塞,DSA均显示动脉瘤完全闭塞。结论颅内动脉瘤栓塞术后再通与初始治疗的闭塞程度、栓塞材料等因素有关。对闭塞不完全的动脉瘤,应通过DSA进行随访,若明显再通,需及时补充栓塞。Objective To explore the problems of recanalization and rebleeding after intracranial aneurysm embolization and the necessity of digital subtraction angiography （DSA） follow-up. Methods One hundred and two patients with intracranial aneurysm （114 aneurysms, of them, 2 patients with multiple intracranial aneurysms, each with one small aneurysm did not coiled ） were selected for endovascular embolization with Guglielmi detachable coil （GDC）, electrolytical detachable coil （EDC）, mechanical detachable spiral （MDS） or Matrix detachable microcoils and were followed-up by the DSA from January 1997 to January 2005. The mean follow-up period was 10. 5 months （ 1 month to 6. 5 years） after the procedures. They were compared with the immediate DSA images after the embolizations. Results Endovascular coiling procedures were performed in ll2 aneurysms. 100% occlusion was 51.79% （58/112） after the initial embolization, ≥95% occlusion was 33.04% （37/112）, and 〈 95% occlusion was 15. 17% （17/112）. After embolization, 87 （77.68%） patients the coils were stable, 6 patients with residual aneurysms （5.36%）, and 19 aneurysms （ 16. 96% ） recanalized. Among the 90 aneurysms embolized with GDC or EDC, 14 （ 15.56% ） recanalized. Among the aneurysms with 100%, ≥95% and 〈 95% occlusion, their recanalize rates after the procedures were 4. 08% , 26. 67% and 36. 36% , respectively, and there were significant differences among them （ P 〈 0. 01 ）. Nine recanalized aneurysms were reembolized with GDC, and rebleeding did not occur. Among 5 recanalized aneurysms, 1 aneurysm experienced rebleeding later. Of the 18 aneurysms embolized with MDS recanalization, 5 recanalized during the follow-up period. The aneurysms treated with Matrix detachable microcoils or Neuroform stents ＋ Matrix detachable microcoils, the aneurysms were occluded completely on follow-up DSA, even the inital occlusions were nearly complete or incomplete. Conclusion The recanalization of intracranial aneurysms i

关 键 词：颅内动脉瘤 栓塞 治疗性 血管造影术 数字减影 随访研究 微弹簧圈 

分 类 号：R743[医药卫生—神经病学与精神病学] R814.43[医药卫生—临床医学]