支架辅助弹簧圈栓塞治疗破裂颈内动脉段微小动脉瘤  

Treatment of ruptured tiny aneurysms of internal carotid artery by stents combined with spring coil

作　　者：程飞飞[1] 蒋永祥[1] 马颖[1] 程远[1] 

机构地区：[1]重庆医科大学附属第二医院神经外科,400010

出　　处：《重庆医学》2016年第26期3652-3654,3657,共4页Chongqing medicine

摘　　要：目的分析支架辅助弹簧圈栓塞术治疗破裂颈内动脉段微小动脉瘤(直径≤3mm)的临床经验及技巧。方法回顾性分析2011年12月到2014年12月该院神经外科采用支架辅助弹簧圈栓塞治疗破裂颈内动脉段微小动脉瘤19例,对术中经历,术中术后近、远期并发症,栓塞率,手术技巧及预后进行分析。结果 (1)19个微小动脉瘤均成功栓塞,成功率为100%,其中采用支架稳定微导管技术(Jailing)治疗14个动脉瘤,支架半释放技术治疗3个,支架稳定微导管技术与微导管穿越支架技术(Mesh)相结合方法治疗2个。(2)术中即刻栓塞效果Raymond分级1级8个,2级6个,3级5个。远期随访无一例复发,Raymond分级1级14个,2级3个,3级2个.(3)术中破裂出血2例,及时救治无不良后果;术中发生脑血管痉挛1例,术后住院期间发生短暂缺血性神经损害。结论支架辅助弹簧圈栓塞术是目前治疗破裂颈内动脉段微小动脉瘤常用和有效的方法之一。Objective To summarize and analyze the clinical experience and technique of stems combined with coil emboliza- tion in the treatment of ruptured tiny aneurysms of internal carotid artery（diameter 3 mm or less）. Methods Retrospective analysis was used to investigate 19 cases of tiny aneurysms of internal carotid artery who were treated with stems combined with spring coil between Dec. 2011 to Dec. 2014. Moreover, the intraoperative experience, the short and long term complications involved in intraop- erative and postoperative therapy, the rate of embolism,the operation skills and prognosis were also explored. Results （1） The 19 tiny aneurysms were embolized successfully with the success rate of 100 %. The 14 aneurysms were treated with stents stable micro catheter technique（Jailing）, the 3 aneurysms were treated with support semi release technology, the other 2 aneurysms were treated with the combination of stents stable micro catheter technology（Jailing） and micro catheter crossing support technology（Mesh）; （2） the effects of intraoperative immediate embolism Raymond class was as follows ;Grade 1 （8 cases）, Grade 2 （6 cases）, Grade 3 （5 cases）. No recurrence was observed by long-term follow-up, with the Raymond elass：Grade 1（14 cases）,Grade 2 （3 eases） ,Grade 3 （2 cases） ;（3） The 2 cases occurred intraoperative ruptured hemorrhage. However, no adverse prognosis was appeared owing to im- mediate treatment;one case showed cerebral vasospasm, resulting in transient ischemie neuronal damage in postoperative hospital stay. Conclusion Stents combined with coil embolization is one of the common and effective strategy for the treatment of ruptured tiny aneurysms of internal carotid artery. Despite the existence of certain complications rates, the total curative effects of this meth- od are worthy of recogniuon.

关 键 词：支架 动脉瘤 颈内动脉 血管内介入 破裂 

分 类 号：R651.12[医药卫生—外科学]