破裂与未破裂颅内微小动脉瘤的血管内治疗  

Endovascular treatment of ruptured and unruptured intracranial very small aneurysms

作　　者：王大明[1] 刘加春[1] 王利军[1] 陆军[1] 祁鹏[1] 翟乐乐[1] 姜学丽[1] 

机构地区：[1]北京医院神经外科,100730

出　　处：《中华医学杂志》2010年第15期1020-1023,共4页National Medical Journal of China

摘　　要：目的评价破裂与未破裂颅内微小动脉瘤（动脉瘤最长径≤3mm）血管内治疗的可行性和安全性。方法回顾分析2001年6月至2009年8月北京医院44例48个的颅内微小动脉瘤的临床、影像学、血管内治疗和随访资料。44例患者中，男20例，女24；平均年龄57．8岁；Hunt—Kosnik分级：0、1～2和3～4级的患者分别为11、23和9例，1例无法确定分级。48个动脉瘤中，动脉瘤瘤体最长径均≤3mm；前交通、大脑中、后交通和颈内动脉动脉瘤依次分别为11、8、14和12个，胼周、椎和小脑后下动脉动脉瘤各1个。39个动脉瘤用弹簧圈行囊内栓塞（其中13个辅以支架，6个栓塞临时使用了球囊），9个动脉瘤仅在载瘤动脉内放置了支架。结果39个囊内栓塞的动脉瘤中，9个动脉瘤100％栓塞，20个90％，9个80％，1个〈80％。术中破裂出血1例；术后一过性轻偏瘫2例，小脑梗塞致共济失调1例。对所有患者临床随访4～90个月无出血，13例在术后4—72个月复查血管造影，未见动脉瘤再生长。结论破裂与未破裂的颅内微小动脉瘤的血管内治疗技术上可行，操作相对安全，初步结果有效。Objective To evaluate the feasibility and safety of endovascular treatment of ruptured and unruptured intracranial very small aneurysms （ ≤3 mm in maximal diameter）. Methods Forty-eight intracranial very small aneurysms in 44 patients treated with endovascular therapy from June 2001 to August 2009 were reviewed retrospectively in clinical, imaging, interventional and follow-up data. Among 44 patients, there were 20 males and 24 females with a mean age of 57.8 years old. The Hunt-Kosnik grade was as follows ： Grade 0 （ n = 11 ） ; Grades I ＆ II （ n = 23 ） ; Grades III ＆ IV （ n = 9） ; and ungraded （ n = 1 ）. The sizes of 48 aneurysms were not more than 3 mm in maximal diameter. The locations of aneurysms were as follows ： ACoA （ n = 11 ）, MCA （ n = 8 ）, PCoA （ n = 14 ）, ICA （ n = 12）, pericallosal artery （ n = 1 ）, VA （n = 1） and PICA （n = 1 ）. Thirty-nine aneurysms were embolized with coil, of which 13 with stent assistance and 6 by balloon remodeling technique. The other 9 aneurysms underwent sole stent placement in parent artery. Results Among 39 coiling aneurysms, 100% occlusion was achieved in 9 aneurysms, 90% in 20, 80% in 9 and less than 80% in 1 respectively. Only one aneurysm ruptured during coiling. Two patients had transient hemiparesis and one patient had ataxia caused by bilateral cerebellar infarction postoperatively. All patients were clinically followed up for 4-90 months and no recurrent hemorrhage occurred. Thirteen patients received repeat angiography at 4-72 months post-treatment. And no radiological re-growth was detected. Conclusion Endovascular treatment of ruptured and unruptured intracranial very small aneurysms seems to be technically feasible, relatively safe and practically effective.

关 键 词：颅内微小动脉瘤 破裂 未破裂 血管内治疗 

分 类 号：R651[医药卫生—外科学] R74[医药卫生—临床医学]