破裂分叶状前交通动脉动脉瘤的血管内治疗:24例回顾性病例系列研究  

Endovascular treatment of ruptured lobulated anterior communicating artery aneurysms:A retrospective case series study of 24 patients

作　　者：黄生炫 陈智勇 李仁满 康泽辉 黄学伟 陈源 Huang Shengxuan;Chen Zhiyong;Li Renman;Kang Zehui;Huang Xuewei;Chen Yuan(Department of Neurosurgery,Sanming First Hospital Affiliated to Fujian Medical University,Sanming,365000,China)

机构地区：[1]福建医科大学附属三明第一医院神经外科,三明365000

出　　处：《国际脑血管病杂志》2023年第3期197-204,共8页International Journal of Cerebrovascular Diseases

基　　金：福建省卫生健康中青年骨干人才培养项目(2021GGB022);福建医科大学启航基金(2019QH1262);福建省自然科学基金(2020J011273)。

摘　　要：目的探讨血管内治疗破裂分叶状前交通动脉动脉瘤(anterior communicating artery aneurysm,ACoAA)的有效性和安全性。方法回顾性纳入2020年6月至2022年6月在福建医科大学附属三明第一医院接受血管内治疗的破裂分叶状ACoAA患者,收集患者人口统计学、临床和影像学特征、血管内治疗方式以及随访结果。结果共纳入24例破裂分叶状ACoAA患者,男性9例(37.5%),女性15例(62.5%);年龄(56.2±8.9)岁(范围39~74岁)。破裂至血管内治疗时间(10.9±12.5)h;动脉瘤最大直径(5.1±1.0)mm;颈宽(3.0±0.7)mm;双分叶19例(79.2%),多分叶5例(20.8%)。Fisher分级:2级16例(66.7%),3级6例(25%),4级2例(8.3%)。Hunt-Hess分级:0~2级5例(20.8%),3~5级19例(79.2%)。格拉斯哥昏迷量表评分:9~12分14例(58.3%),13~15分10例(41.7%)。术后即刻Raymond-Roy分级:1级23例(95.8%),2级1例(4.2%)。2周~3个月影像学随访Raymond-Roy分级:1级23例(95.8%),2级1例(4.2%)。2~12个月随访显示,21例(87.5%)功能转归良好(改良Rankin量表评分≤2分),无死亡病例。结论血管内治疗对于破裂分叶状AcoAA是一种安全和有效的治疗方式。Objective To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm(ACoAA).MethodsPatients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included.Their demographic,clinical and imaging characteristics,endovascular treatment methods and follow-up results were collected.ResultsA total of 24 patients with ruptured lobulated ACoAA were included,including 9 males(37.5%)and 15 females(62.5%).Their age was 56.2±8.9 years old(range 39-74).The time from rupture to endovascular treatment was 10.9±12.5 h.The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width was 3.0±0.7 mm.Nineteen patients(79.2%)were double-lobed and 5(20.8%)were multilobed.Fisher's grade:grade 2 in 16 cases(66.7%),grade 3 in 6 cases(25%),and grade 4 in 2 cases(8.3%).Hunt-Hess grade:grade 0-2 in 5 cases(20.8%),grade 3-5 in 19 cases(79.2%).Glasgow Coma Scale score:9-12 in 14 cases(58.3%),13-15 in 10 cases(41.7%).Immediately postprocedural Raymond-Roy grade:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Raymond-Roy grade in imaging follow-up for 2 weeks to 3 months:grade 1 in 23 cases(95.8%),grade 2 in 1 case(4.2%).Follow-up for 2 to 12 months showed that 21 patients(87.5%)had good functional outcomes(modified Rankin Scale score≤2),and there were no deaths.ConclusionEndovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.

关 键 词：颅内动脉瘤 动脉瘤 破裂 大脑前动脉 血管内手术 栓塞 治疗性 治疗结果 

分 类 号：R651.12[医药卫生—外科学]