脉络膜前动脉微小动脉瘤的介入治疗  

Endovascular treatment of tiny anterior choroidal artery aneurysms

作　　者：李强[1] 许奕[1] 张琪[1] 洪波[1] 黄清海[1] 方亦斌[1] 刘建民[1] 

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433

出　　处：《中华神经外科杂志》2010年第3期223-227,共5页Chinese Journal of Neurosurgery

基　　金：基金项目：上海市科委重点项目（074119506）;上海市优秀学科带头人项目（07XD14026）

摘　　要：目的评价脉络膜前动脉微小动脉瘤介入治疗的效果。方法回顾分析介入治疗的12例共12枚脉络膜前动脉微小动脉瘤。其中9枚为破裂动脉瘤；10枚动脉瘤脉络膜前动脉起自瘤颈。结果单纯弹簧圈栓塞6枚，支架辅助栓塞4枚，球囊辅助栓塞1枚；另外单纯支架治疗1枚。除该枚动脉瘤外，2枚致密栓塞，4枚瘤颈残留，5枚不完全栓塞。2例术后发生脉络膜前动脉综合征，其中1例为一过性。1例发生术中出血。9例获得造影随访，3枚动脉瘤保持稳定，3枚进一步闭塞，2枚瘤颈愈合；1枚复发，但无需再治疗。结论介入治疗脉络膜前动脉微小动脉瘤是安全可行的，支架有利于保持脉络膜前动脉通畅并促进动脉瘤愈合。Objective To evaluate the efficacy and feasibility of endovascular treatment in the management of tiny anterior choroidal artery aneurysms（AChANs） with the maximum diameter not more than 3 mm. Method 12 cases with 12 tiny AChANs treated with endovascular methods from July 1999 to July 2009 were retrospectively evaluated. 11 patients presented with spontaneous subaraehnoid hemorrhage. Among the 12 aneurysms,9 were ruptured, 10 wide -necked and 10 with ipsilateral anterior choroid arteries （AChAs） involved in the necks. Results 6 aneurysms were managed with simple coil embolization, and balloon remodeling technique was used in 1 case. 5 cases underwent intravascular stent implantation. Coil packing was done in 4 of 5 aneurysms, and stent implantation alone was used in the remaining aneurysms Immediate postoperative angiography demonstrated complete occlusion in 2 aneurysms, neck remnant in 4 and incomplete occlusion in 5 among the coil packed ones. The anterior choroidal artery syndrome（AChAS） happened in one of the 2 cases whose ipsilateral AChAs were showed occluded by the immediate angiography. Another patient a/so encountered transient AChAS despite the patent AChA. Intraoperative hemorrhage was encountered in 1 patient, who recovered well after the procedure. With the exception of 1 patient （Hunt and Hess grade 4 ） who was loss in follow - up duration, there was no hemorrhagic complication during the follow - up period in the remaining 11 patients. Follow - up angiography in 9 patients showed that 3 aneurysms remained stable, 3 were getting better, 2 aneurysms treated with stent totally healed, and only one aneurysm reeanalization was found. Conclusions Endovascular treatment is a feasible and effective therapeutic alternative for tiny AChANs. The AChA should be kept patent during the procedure to avoid AChAS. Stent is helpful for the patency of AChAs and healing of TAChANs.

关 键 词：脉络膜前动脉动脉瘤 微小动脉瘤 介入治疗 脉络膜前动脉梗死 

分 类 号：R74[医药卫生—神经病学与精神病学]