颅内微小动脉瘤微导管插管稳定到位的不利因素与对策  

Endovascular treatment of micro-intracranial aneurysms：adverse factors of micro-catheterization and its relevant managements

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

机构地区：[1]卫生部北京医院神经外科,100730

出　　处：《中华外科杂志》2010年第19期1463-1465,共3页Chinese Journal of Surgery

摘　　要：目的 探讨颅内微小动脉瘤血管内治疗时妨碍微导管插管和稳定到位的不利因素及其对策.方法 回顾2001年6月至2009年10月间46例51个颅内微小动脉瘤的血管内治疗资料,分析术中微导管插管和稳定到位的影响因素及其相应的可能对策.结果 在血管内治疗时可能妨碍微导管插管和稳定到位的因素有：微导管走行的路径,载瘤动脉迂曲,路径、载瘤动脉直径与微导管直径相差较大,路径、载瘤动脉的走行方向与动脉瘤瘤顶的指向不在同一方向且差异较大,以及载瘤动脉内动脉瘤颈处放置了支架.结论 根据路径、载瘤动脉的走行、动脉瘤的位置和瘤顶的指向,选择顺应性、稳定性与导引性、支撑性适宜并匹配的微导管与微导丝,并对其头端进行塑形,酌情选用球囊或（和）支架辅助,加之娴熟的插管技术,是颅内微小动脉瘤血管内治疗时微导管插管和稳定到位的有效方法 .Objectives To investigate adverse factors that may hinder successful placement and stabilization of the microcatheter during endovascular therapy of micro-intracranial aneurysms （≤ 3 mm in maximum diameter）, and to explore the relevant managements. Methods Forty-six patients with fifty-one micro-intracranial aneurysms treated by endovascular therapy from June 2001 to October 2009 were retrospectively analyzed for their intervention data. Results Adverse factors of optimal micro-catheterization mainly included, tortuosity of the proximal vessels （PVs）and the parent artery （PA）, relative large gap in diameter among the PVs, the PA and the microcatheter, relative large divergence in direction among the PVs, the PA and the aneurysm dome, and stent deployed in the PA. Conclusions Carefully considering the direction of the PVs and the PA, the aneurysm＇s location and dome orientation,choosing the microcatheter and microwire after balancing among their physical properties, as well as utilizing balloon and/or stent assistance, can facilitate micro-catheterization during endovascular treatment of micro-intracranial aneurysms.

关 键 词：颅内动脉瘤 导管插入术 血管内治疗 

分 类 号：R686[医药卫生—骨科学]