支架辅助弹簧圈治疗前交通动脉破裂微小动脉瘤  

Stent-assisted coil embolization of ruptured anterior communicating artery tiny aneurysms

作　　者：邹超[1] 黄清海[1] 赵瑞[1] 许奕[1] 洪波[1] 赵文元[1] 刘建民[1] 

机构地区：[1]第二军医大学长海医院神经外科,上海200433

出　　处：《中国脑血管病杂志》2013年第1期9-12,共4页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81210108031)

摘　　要：目的探讨支架辅助弹簧圈栓塞治疗前交通动脉破裂微小动脉瘤(直径≤3 mm)的安全性及有效性。方法回顾性分析2009年2月—2012年2月,第二军医大学长海医院神经外科采用支架辅助弹簧圈栓塞(支架后释放技术)治疗的26例前交通动脉破裂微小动脉瘤患者的临床资料,评价其安全性及有效性。结果①26例患者均获成功栓塞,其中致密栓塞15例(57.6%),瘤颈残余6例,大部分栓塞5例;载瘤动脉血流均通畅。②术后1.5～72.0个月行临床随访,26例中无一例再次发生动脉瘤相关性出血及血栓栓塞症状。1例Hunt-HessⅣ级患者术后6周死于心、肺功能衰竭。23例完全恢复正常,2例发生轻度神经功能障碍,但生活能够自理。③22例术后6～24个月获DSA随访,14例致密栓塞患者中无一例复发;5例瘤颈残余者中4例动脉瘤不显影,1例血栓进一步形成;3例大部栓塞的患者,2例动脉瘤不显影,1例血栓进一步形成。20例动脉瘤不显影的患者中,10例可见明显的愈合线。结论支架辅助弹簧圈栓塞技术治疗前交通动脉破裂微小动脉瘤安全、有效;支架后释放技术可提高动脉瘤栓塞率及长期预后的良好率。Objective To evaluate the safety and efficacy of stent-assisted coil embolization （ stent- ing after coiling technique） of anterior communicating artery tiny aneurysms. Methods The clinical data of 26 patients with ruptured anterior communicating artery tiny aneurysms treated with stent-assisted coil embolization at the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University from February 2009 to February 2012 were analyzed retrospectively. Its safety and efficacy were evaluated. Results （1）All aneurysms were embolized successfully in 26 patients, among them 15 （57.6%） were densely packed, 6 had residual aneurysm necks, and 5 were subtotally embolized. The parent arteries were all patent. （2）All the 26 patients were followed up for 1.5 to 72 months after procedure, none of them had aneurysm-related rebleeding and thromboembolic symptoms. One patient with Hunt-Hess IV died of heart- lung failure at 6 weeks after procedure. Twenty-three patients completely returned to normal, 2 had mild neurological dysfunction, but they could take care of themselves. （3）At 6 to 24 months after procedure, 22 patients were followed up with DSA. None of the 14 densely packed aneurysms had recurrence; among the 5 patients with residual aneurysm neck, the aneurysms did not develop in 4 patients, and 1 had further thrombosis; among the 3 patients with subtotal embolization, the aneurysms did not develop in 2 patients, and 1 had further thrombosis. Conclusion The treatment of anterior communicating artery tiny ancu- rysms with stent-assisted coil embolization is safe and effective. Stenting after coiling technique may improve the rate of aneurysm embolization and long-term good prognosis.

关 键 词：动脉瘤 破裂 支架 弹簧圈 微小动脉瘤 前交通动脉 

分 类 号：R743.3[医药卫生—神经病学与精神病学]