颅内动脉瘤栓塞术中出血易忽视的影像表现--血流变慢  

An easily overlooking imaging manifestation of hemorrhage occurred during the performance of embolization therapy for intracranial aneurysm: the slowed blood flow sign

作　　者：肖兵[1] 宋建琼[2] 刘春平[3] 刘谊[3] 蔡洪[3] 陈忠[3] 

机构地区：[1]四川省达州市中心医院介入科,635000 [2]四川省达州市中心医院功能科,635000 [3]四川省达州市中心医院神经内科,635000

出　　处：《介入放射学杂志》2013年第3期235-238,共4页Journal of Interventional Radiology

摘　　要：目的分析颅内动脉瘤弹簧圈栓塞治疗术中出血的影像学表现。方法回顾性分析358例颅内动脉瘤采用介入栓塞治疗患者病史及造影资料,其中10例术中出血。10例中4例利用支架辅助弹簧圈栓塞术,2例双导管弹簧圈栓塞术,4例单纯弹簧圈栓塞术治疗。结果 8例弹簧圈栓塞过程中出血,出血表现为对比剂外溢,载瘤血管一过性血流变慢,其中5例弹簧圈突出瘤壁,1例微导管突出瘤壁外,2例微导丝突出瘤壁外;另2例为弹簧圈栓塞中造影仅见血流明显变慢,未见对比剂外溢及微导管、微导丝和弹簧圈突出瘤壁,术后CT证实为出血。10例术中破裂者中9例致密栓塞,1例部分栓塞,术后对症治疗7例,开颅引流减压3例。6例恢复好,1例一过性动眼神经麻痹,3例死于颅内压增高。结论术中出血导致的载瘤血管血流变慢易被忽视,而此征象与患者预后密切相关。Objective To analyze the imaging manifestations of bleeding due to ruptured intracranial aneurysm occurred during the performance of endovascular embolization for intracranial aneurysm. Methods A total of 358 patients with intracranial aneurysm, who were treated with endovascular embolization, were enrolled in this study. The clinical data were retrospectively analyzed. Of the 358 patients, intracranial hemorrhage that occurred during the procedure was seen in 10. Of the 10 patients having hemorrhage, stent-assisted coil embolization was carried out in 4, dual- catheter coil embolization was employed in 2, and simple coil embolization was performed in 4. Postoperative symptomatic management was adopted in 7 patients, and craniotomy decompression drainage was used in 3 patients. The clinical results were analyzed. Results During the performance of coil embolization contrast extravasation and transient slowed blood flow within the parent artery were seen in 8 cases. The steel coil stuck out from the aneurysmal wall in five cases, the micro- catheter protruded from the aneurysmal wall in one case, and micro- guidewire penetrated the aneurysmal wall in two cases. In two cases, angiography performed during coil embolization procedure showed that only slowed blood flow was seen, and neither contrast extravasation nor penetration of the aneurysmal wall by micro- catheter, micro guidewire or coil could be found. However, postoperative CT scanning confirmed the presence of bleeding in these two cases. Of the 10 patients with ruptured intracranial aneurysm, complete embolization was obtained in 9 and partial embolization was obtained in one case. Postoperative symptomatic management was adopted in 7 patients, and craniotomy decompression drainage was used in 3 patients. After the treatment, six patients recovered well, one patient had transient oculomotor paralysis, and three patients died from intracranial hypertension. Conclusion Slowed blood flow within the parent artery that is caused by the bleeding due to the rupture

关 键 词：颅内动脉瘤 弹簧圈 栓塞 术中出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]