Enterprise支架辅助栓塞颅内动脉瘤并发症原因分析及处理  

Cause analysis and management of the complications of Enterprise stent-assisted embolization of intracranial aneurysms

作　　者：陈三送[1] 方兴根[1] 李真保[1] 狄广福[1] 赵心同[1] 吴德刚[1] 赖年升[1] 刘佳强[1] 张家旗[1] 

机构地区：[1]皖南医学院第一附属医院弋矶山医院神经外科,安徽省芜湖市241001

出　　处：《中国脑血管病杂志》2015年第8期421-425,434,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析Enterprise支架辅助栓塞颅内动脉瘤术中、术后常见并发症及其原因和防治措施。方法回顾性分析皖南医学院第一附属医院弋矶山医院神经外科2012年1月至2014年3月经Enterprise支架辅助治疗的143例颅内动脉瘤患者术中、术后出现的常见并发症及其可能原因,以及采取的相应处理措施,并观察预后情况。结果共纳入143例(共205个动脉瘤)颅内动脉瘤患者,其中未破裂动脉瘤43例,复发动脉瘤12例,破裂动脉瘤88例,共使用Enterprise支架170枚。治疗过程中,共出现22例并发症,发生率为15.4%;其中,术中动脉瘤破裂出血2例,经积极救治后恢复良好出院;急性血栓形成13例,经替罗非班和(或)尿激酶,微导管、导丝接触溶栓,11例即刻血流完全恢复,1例溶栓失败,1例血流缓慢,术后6例患者出现不同程度脑梗死,1例死亡(术前Hunt-HessⅣ级);血管痉挛3例,经减少血管壁刺激及罂粟碱灌注后好转;术中支架导引导丝断裂,支架到位困难1例;术中最后1枚弹簧圈填塞困难,凸入载瘤动脉1例;术后非动脉瘤性出血2例,1例经保守治疗后遗留一侧肢体肌力下降,1例经开颅手术后病情稳定,遗留失语及一侧肢体偏瘫。结论应用Enterprise支架辅助栓塞颅内复杂动脉瘤时,需严格掌握适应证,加强围手术期管理及提高术中操作技巧,可减少或避免并发症的发生。Objective To analyze the intraoperative and postoperative common complications of Enterprise stent-assisted embolization of intraeranial aneurysms and the causes and preventive measures. Methods One hundred forty-three patients with intraeranial aneurysm treated with Enterprise stent-assisted embolization at the Department of Neurosurgery, Yijishan Hospital, the First Hospital Affiliated to Wannan Medical College from January 2012 to March 2014 were analyzed retrospectively. The common intraoperative and postoperative complications and its possible causes, as well as the appropriate management were analyzed, and the prognoses were observed. Results A total 143 patients （205 aneurysms） with intracranial aneurysm were enrolled, included 43 with unruptured aneurysm, 12 with recurrent aneurysm, and 88 with ruptured aneurysm. A total of 170 Enterprise stents were used. Twenty-two patients （ 15.4% ） had complications. Among them,2 had intraoperative aneurysm rupture, and they recovered well and discharged after active treatment. Thirteen patients had acute thrombosis, 1 1 of the patients completely restored blood flow immediately after tirofiban and/or urokinase, microcatheter and guidewire-contact thrombolysis. The thrombolysis failed in 1 patient, and the blood flow was slow in 1 patient. Six patients had different degrees of cerebral infarction after procedure, and 1 died （ peroperative Hunt-Hess grade Ⅳ ）. Three patients had vasospasm and they were improved after reducing blood vessel wall irritation and papaverine infusion. The introperalive stent guidewire was broken and the stent in place was difficult in 1 case. The last coil packed difficultly during the procedure, and it protruded into the parent artery in 1 case. Two patients had non-aneurysmal hemorrhage after procedure. After conservative treatment, one left unilateral limb muscle strength decline and the other was stable after craniotomy, but leaving aphasia and hemiplegia. Conclusion When using the Enterprise stent-assisted embolization for

关 键 词：颅内动脉瘤 Enterprise支架 并发症 

分 类 号：R743[医药卫生—神经病学与精神病学]