单侧A1优势前交通动脉瘤的栓塞治疗(附48例报告)  

Embolization for the treatment of unilateral A1 segment anterior communicating artery aneurysm: a report of 48 cases

作　　者：郭庆东[1] 刘伟[1] 付洛安[1] 张磊[1] 张学析[1] 胡晶[1] 费舟[1] 

机构地区：[1]第四军医大学西京医院神经外科,西安710032

出　　处：《解放军医学杂志》2011年第10期1086-1087,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的总结使用可脱弹簧圈栓塞治疗48例单侧A1优势前交通动脉瘤的经验和方法。方法 2009年1月-2010年4月西京医院收治的单侧A1优势前交通动脉瘤患者48例,其中男23例,女25例,年龄32～72岁,平均53.4岁。全部动脉瘤均在术中应用旋转成像图像后处理技术,并采用弹簧圈进行动脉瘤内栓塞治疗,采用双侧颈动脉置管技术监测栓塞术中载瘤动脉通畅情况。对宽颈动脉瘤采用支架辅助技术,球囊辅助瘤颈重塑形技术,微导管、微导丝辅助技术保持载瘤动脉通畅。其中38例术后6个月复查全脑血管造影,了解已栓塞动脉瘤及前交通动脉通畅情况。结果 48例患者中动脉瘤致密栓塞39例(81.25%),90%以上栓塞6例(12.50%),90%以下栓塞3例(6.25%);术中出血1例(2.08%),前交通动脉闭塞3例(6.25%),前交通动脉闭塞后对侧代偿2例(4.17%)。随访均无再出血,38例复查全脑血管造影见动脉瘤栓塞致密、前交通动脉血流通畅。结论单侧主供血前交通动脉瘤栓塞治疗术中应注意保持前交通动脉通畅,使用微导管或微导丝置于瘤颈处辅助栓塞有一定帮助。Objective To summarize the experience and method of endovascular treatment of unilateral A1 segment anterior communicating artery aneurysm with detachable coils.Methods Forty-eight patients with unilateral A1 anterior communicating artery aneurysm（23 males and 25 females,age ranged from 32 to 72 years with mean of 53.4,hospitalized in Xijing hospital from Jan.2009 to Apr.2010） were involved in present study.All of the aneurysms were measured with rotational digital subtraction angiography（RDSA） and image post-processing techniques,and they were embolized with Guglielmi detachable coils（GDCs）.The patency of the parent arteries was monitored by catheterization in both carotid arteries in the process of treatment.Stent-assisted,balloon remodeling,microcatheter and microwire assisted techniques were used in the treatment of wide-necked aneurysm to keep patency of parent arteries.Cerebral angiography was performed in 38 cases 6 months after the operation to observe the patency of embolized aneurysms and anterior communicating arteries.Results Of the 48 cases,total occlusion was achieved in 39（81.3%）,more than 90% occlusion was achieved in 6（12.5%）,and 3（6.3%） with less than 90% occlusion;1 had hemorrhage during embolization,3 had anterior communicating artery occlusion,and 2 had contralateral internal carotid artery compensation after anterior communicating artery occlusion.No re-bleeding was found during the 6 months follow-up period.Cerebral angiography showed total occlusion of aneurysms and patency of anterior communicating arteries in 38 cases during re-examination.Conclusion The anterior communicating arteries should be kept patent in embolization treatment of the major unilateral blood supply anterior communicating artery aneurysms,and it is helpful to use microcatheter or microwire assisted techniques.

关 键 词：电解可脱卸弹簧圈 颅内动脉瘤 栓塞 治疗性 

分 类 号：R651.122[医药卫生—外科学]