脑血管介入栓塞性并发症的处理及预后  

Report of 3 cases of embolic complication during cerebral vascular interventional treatment

作　　者：张健[1] 韩志安[1] 张勇[1] 吴泳均[1] 李晓群[1] 

机构地区：[1]中山市人民医院介入治疗室,广东528403

出　　处：《影像诊断与介入放射学》2013年第4期305-307,共3页Diagnostic Imaging & Interventional Radiology

摘　　要：目的报告3例脑血管疾病介入治疗术中出现的栓塞性并发症的处理过程，讨论脑血管介入手术中出现栓塞性并发症的原因、治疗及预防方法。方法回顾性分析我院2009～2013年脑血管介入手术术中出现的3例栓塞性并发症病例。详细复习3例病例的病史、术前检查、手术过程、并发症的发现、处理措施及预后。分析栓塞性并发症发生的原因、预防及总结经验。结果3例病例均在脑血管介入治疗术后出现栓塞性并发症。病例1颈内动脉瘤栓塞术中，在调整微导管位置时致已填入的两个微弹簧圈脱落，顺血液方向滞留于右侧大脑中动脉分叉处，20h后出现左侧肢体偏瘫，立即行右侧颈内动脉造影，发现右侧大脑中动脉分叉脱落滞留弹簧圈处形成血栓栓塞，以尿激酶溶栓后以抓捕器（Lasso）成功取出脱落的微弹簧圈。病例2为脑动一静脉畸形栓塞术中出现血栓致远端血管栓塞，立即经导管行尿激酶溶栓治疗，复通了远端动脉。病例3为脑动脉瘤栓塞治疗结束时气栓栓塞远端脑动脉，经微导管、微导丝处理搅散气泡后成功疏通了栓塞的脑动脉。结论脑血管介入治疗术中出现栓塞性并发症时，应根据栓塞的原因、栓塞的部位、栓塞的材料、栓塞的时间等采取不同的处理措施，如抓捕器（Lasso）取出异物，严密监测下的紧急溶栓治疗或减小栓塞气体体积的搅散气泡等。当然术中仔细、严格、规范的操作可从源头上避免严重的并发症。Objective To report 3 cases of embolic complication during cerebral vascular interventional treatment. Methods The clinical records of 3 patients with embolic complications during cerebral vascular interventional treatment from 2009 to 2013 were reviewed. The cause, prevention and prognosis of the embolism were analyzed. Results Case 1 ： During embolization of internal carotid aneurysm and adjustment of the microcatheter position, two microcoils were dislodged to the right middle cerebral artery bifurcation resulting in left hemiplegia 20 hours later. Right internal carotid angiography showed thrombosis of the right middle cerebral artery bifurcation around the stranded microcoils. After urokinase thrombolysis, the coils were removed successfully using Lasso capture device. Case 2： Embolization of arteriovenous malformation was complicated by distal arterial embolism. The thrombus was dissolved using transcatheter urokinase treatment. Case 3： After cerebral anenrysm embolization, a gas bubble was lodged in the remote cerebral artery. The gas bubble was dispersed using microcatheter and microthread. Conclusions Embolie complication of cerebrovascular intervention can be managed according to the cause, composition, location, and time of embolism using capture device to remove the foreign body, emergency thrombolytic therapy under careful monitoring, or dispersion to reduce the volume of gas bubble.

关 键 词：脑血管介入 栓塞 并发症 处理 

分 类 号：R743[医药卫生—神经病学与精神病学]