介入治疗颅内动脉瘤局部合并严重狭窄的疗效分析  

Curative effect of endovascular techniques on aneurysms associated with intracranial severe stenosis

作　　者：李钊硕[1] 李天晓[1] 薛绛宇[1] 冯光[1] 王子亮[1] 白卫星[1] 赵同源[1] 梁晓东[1] 

机构地区：[1]郑州大学人民医院脑血管介入治疗中心(河南省人民医院介入科),河南省介入治疗中心,河南省脑血管病防治中心,郑州450003

出　　处：《中华神经医学杂志》2015年第12期1224-1229,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨介入治疗颅内动脉瘤局部合并严重狭窄的疗效和并发症。方法郑州大学人民医院脑血管介入治疗中心自2009年7月至2015年7月采用血管内介入治疗颅内动脉瘤局部合并严重狭窄患者26例，根据动脉瘤形态将病变分为简单型（Ⅰ型）、复杂型（Ⅱ型1，评估手术路径并分为a亚型和b亚型，依据不同分型选择合适的腔内介入治疗策略。结果26例患者均获得腔内栓塞治疗，其中单纯弹簧圈栓塞10例，双微导管栓塞1例，球囊辅助栓塞1例，支架辅助栓塞14例。其中Ia型5例，采用单纯弹簧圈栓塞4例，支架辅助栓塞1例，结果4例完全栓塞，1例几乎完全栓塞；Ⅰb型5例，采用单纯弹簧圈栓塞4例，支架辅助栓塞1例，结果2例完全栓塞，1例几乎完全栓塞，不完全栓塞2例；Ⅱa型9例，采用单纯弹簧圈栓塞术1例，双微导管栓塞技术1例，支架辅助栓塞治疗7例，结果完全栓塞3例，几乎完全栓塞3例，不完全栓塞3例；Ⅱb型7例，采用单纯弹簧圈栓塞术1例，球囊辅助栓塞1例，支架辅助栓塞治疗5例，结果完全栓塞1例，几乎完全栓塞1例，不完全栓塞5例。发生并发症3例：1例球囊辅助过程中出血死亡，与选用顺应性球囊有关：1例辅助支架在狭窄处展开欠充分，急性血栓形成；1例单纯填塞过程中微量出血合并迟发型血管痉挛，但未遗留神经功能缺失体征。患者平均随访（26±11）月，改良Rankin评分（mRS）0~2分有20例．3分4例，6分2例。结论介入治疗动脉瘤局部合并狭窄难度较大，尤其是复杂型动脉瘤，术前合理的分型可为腔内治疗提供依据。Objective To evaluate the curative effect of endovascular techniques on aneurysms associated with intracranial severe stenosis. Methods Twenty-six patients with aneurysms associated with intracranial severe stenosis, admitted to our hospital from July 2009 to July 2015, were treated with endovascular techniques. The aneurysms were typed according to the morphology and pathway （type Ⅰ and Ⅱ）. Different endovascular interventional therapy strategies （a subtype and b subtype） were selected according to the typing. Results Of the 26 patients, 10 were treated with selective coil occlusion of the aneurysm, one with double microcatheter, one with balloon-coil embolization and 14 with stent-coil embolization. Procedural rupture occurred in one aneurysm mainly caused by the balloon dilation, leading to death. Five patients were the Ia subtype, selective coil occlusion of the aneurysm was adopted in the 4 patients and stent-coil embolization in one, enjoying the results that 4 were completely occluded and one was sub-totally occluded. Five patients were the Ib subtype, selective coil occlusion of the aneurysm was adopted in the 4 patients and stent-coil embolization in one, enjoying the results that two were completely occluded, one was sub-totally occluded, and two were incomplete embolization. Nine patients were the IIa subtype, selective coil occlusion of the aneurysm was adopted in one patient, double microcatheter in one patient, and stent-coil embolization in seven, enjoying the results that three were completely occluded, three was sub-totally occluded, and the other three were incomplete embolization. Seven patients were the Ilb subtype, selective coil occlusion of the aneurysm was adopted in one patient, balloon-coil embolization in one patient, and stent-coil embolization in five, enjoying the results that one were completely occluded, one was sub-totally occluded, and the other five were incomplete embolization. One patient died at the balloon-coil embolization, one patient treated with stent-coil em

关 键 词：颅内动脉瘤 颅内动脉狭窄 血管内治疗 支架辅助栓塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]