微导管复合塑形在弹簧圈栓塞伴有胚胎型大脑后动脉的破裂后交通动脉瘤术中的应用  

Application of multiple shaping microcatheter in coil embolization for ruptured posterior communicating artery aneurysms associated with embryonic type of posterior cerebral artery

作　　者：杜世伟[1] 李静伟[1] 陈健[1] 刘洋[1] 孙力泳[1] 李桂林[1] 张鸿祺[1] DU Shiwei;LI Jingwei;CHEN Jian;LIU Yang;SUN Liyong;LI Guilin;ZHANG Hongqi(Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《介入放射学杂志》2018年第6期495-499,共5页Journal of Interventional Radiology

基　　金：国家重点研发计划项目(2016YFC1301800)

摘　　要：目的 探讨微导管复合塑形在单纯弹簧圈栓塞伴有胚胎型大脑后动脉(fPCA)的破裂后交通动脉瘤(PCoAA)术中的安全性和有效性。方法 回顾性分析2015年6月至2016年12月首都医科大学宣武医院采用微导管复合塑形、单纯弹簧圈栓塞治疗的51例伴有fPCA的中小型破裂PCoAA患者临床资料。评价术中微导管塑形准确性、微导管塑形稳定性、栓塞操作相关并发症、动脉瘤栓塞程度和后交通动脉保留程度、随访时神经功能恢复情况。结果 51例51枚伴有fPCA的破裂PCoAA均通过微导管复合塑形技术成功完成单纯弹簧圈栓塞。术后即刻血管造影显示瘤体完全栓塞43例(84.3%),瘤颈残留8例(15.7%);后交通动脉均保留,49例血流无影响,2例部分影响。微导管塑形准确率为90.2%,其中微导管直接推送到位36例,回拉到位11例,导丝导引到位4例;栓塞中88.2%微导管位置稳定。仅1例术中发生破裂再出血。随访6~24个月显示,改良Rankin量表(mRS)评分≤2分48例(94.1%),3例(5.9%)预后不良,无患者死亡。术后6个月血管复查造影显示,Raymond 1级41枚(80.4%),2级8枚(15.7%),3级2枚(3.9%)。结论 单纯弹簧圈栓塞治疗伴有fPCA的急性期中小型破裂PCoAA术中应用微导管复合塑形技术,可使栓塞过程更稳定和安全,取得了满意效果。Objective To evaluate the safety and effectiveness of the use of multiple shaping microcatheter in performing coil embolization for ruptured posterior communicating artery aneurysm （PCoAA） associated with a fetal posterior cerebral artery （fPCA）. Methods The clinical data of a total of 51 patients with small- medium sized ruptured PCoAA associated with fPCA, who received simple coil embolization therapy by using multiple shaping microcatheter during the period from June 2015 to December 2016 at Xuanwu Hospital, Capital Medical University, Beijing, China, were retrospectively analyzed. The accuracy and stability of microcatheter shaping, procedurerelated complications, embolization degree of aneurysms, preservation degree of posterior communicating artery, and recovery of neurological function at follow-up examination were evaluated. Results A total of 51 ruptured PCoAAs associated with fPCA were detected in 51 patients, and successful simple coil embolization by using multiple shaping microcatheter was accomplished for all 51 ruptured PCoAAs. Angiography performed immediately after embolization revealed that complete embolization of PCoAA was obtained in 43 patients （84.3%）, residual aneurysmal neck was seen in 8 patients （15.7%）. The posterior communicating artery was preserved in all patients. The blood flow was unaffected in 49 patients and was partially affected in 2 patients. The shaping accuracy of the microcatheter was 90.2%. In 36 patients the microcatheter was directly inserted to the right place, in 11 patients the microcatheter entered the right vessel by pulling it back, and in 4 patients the inicrocatheter was placed to the scheduled place with the help of guide wire. During the process of embolization, the position of the microcatheter remained stable in 88.2% of patients. Intraoperative re-bleeding due to aneurysm rupture occurred only in one patient. The patients were followed up for 6-24 months. Modified Rankin scale （mRS） score of ≤2 points was obtained in 48 patients （94

关 键 词：微导管塑形 后交通动脉瘤 胚胎型大脑后动脉 弹簧圈栓塞 

分 类 号：R692.5[医药卫生—泌尿科学]