弹簧圈联合液态栓塞剂治疗小脑后下动脉远端动脉瘤的临床疗效  

Clinical Efficacy of Coil Combined with Liquid Embolization Agent in the Treatment of Distal Ruptured Aneurysms of the Posterior Inferior Cerebellar Artery

作　　者：高志康 崔艳峰 徐浩 张庆桥 肖晋昌 王勇 黄乾鑫 杨晶 张科 GAO Zhikang;CUI Yanfeng;XU Hao(Department of Interventional Radiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221002,P.R.China)

机构地区：[1]徐州医科大学附属医院介入放射科,221002

出　　处：《临床放射学杂志》2024年第11期1986-1991,共6页Journal of Clinical Radiology

基　　金：徐州市科技局重点研发计划项目(编号:KC22237)。

摘　　要：目的探讨弹簧圈联合液态栓塞剂治疗小脑后下动脉远端破裂动脉瘤的有效性和安全性。方法回顾性分析采用弹簧圈联合液态栓塞剂治疗的6例小脑后下动脉远端破裂动脉瘤患者。分析此类患者的一般资料(性别、年龄及出血特点)及临床资料(包括动脉瘤位置、大小和治疗方式、术后即刻结果以及随访结果),所有患者采用弹簧圈联合液态栓塞剂栓塞动脉瘤及载瘤动脉。应用Raymond-Roy分级(R-R分级)评价即刻栓塞程度(Ⅰ级为动脉瘤完全栓塞,Ⅱ级为瘤颈残留,Ⅲ级为动脉瘤瘤体显影)。术后3、6个月进行门诊或电话随访,术后6个月行MRA/CTA影像随访。出院及随访期间采用改良Rankin量表(mRS)评估患者预后(mRS评分≤2分为预后良好,3~6分为预后不良,其中6分为死亡)。结果6例患者中蛛网膜下腔出血5例,其中伴脑室积血1例,伴小脑血肿1例,单纯小脑血肿1例。6例小脑后下动脉远端动脉瘤破裂患者采用弹簧圈联合液态栓塞剂栓塞,即刻造影提示动脉瘤及载瘤动脉闭塞成功;1例术前昏迷患者合并右侧颈内动脉眼段动脉瘤,瘤体形态不规则,一期行支架辅助弹簧圈栓塞术,术后复查头颅CT未见出血增多,术后4天患者仍昏迷,家属放弃治疗,其余患者术后复查CT平扫提示小脑少许梗死灶,4例为无症状脑梗死,1例表现为头晕,5天后缓解。出院时预后良好率为83.3%(5/6)。术后随访3~12个月,无再次出血。结论初步分析,弹簧圈联合液态栓塞剂治疗小脑后下动脉远端破裂动脉瘤安全、有效,术中注意生物胶的弥散,术后定期行影像随访。Objective To investigate the effectiveness and safety of coil combined with liquid embolization agent in the treatment of distal ruptured aneurysms of the posterior inferior cerebellar artery.Methods Retrospective analysis of six patients with distal ruptured aneurysms of the posterior inferior cerebellar artery treated with coils combined with liquid embolization agents.General(gender,age,and bleeding characteristics)and clinical data(including aneurysm location,size and treatment modality,immediate postoperative results,and follow-up results)were analyzed in these patients,all of whom had aneurysms and aneurysm-carrying arteries embolized with a coil combined with liquid embolization agent.R-R grading evaluation immediately after embolization degree(ClassⅠ:complete obliteration;ClassⅡ:residual neck;ClassⅢ:residual aneurysm).Outpatient or telephone follow-up was performed at 3 and 6 postoperative,and MRA imaging follow-up was performed at 6 months postoperative.Patients'prognosis was assessed during discharge and follow-up using the modified Rankin Scale(mRS)(mRS score≤2 was considered good prognosis,3-6 was poor prognosis,of which 6 was death).Results Among the 6 patients,there were 5 cases of subarachnoid hemorrhage,including 1 case with ventricular hemorrhage and 1 case of cerebellar hematoma with subarachnoid hemorrhage,1 case of simple cerebellar hematoma.Six patients with ruptured distal inferior posterior cerebellar artery aneurysms were embolized with a coil combined with liquid embolization agent,and immediate imaging showed successful occlusion of the aneurysm and the aneurysm-carrying artery.A patient in preoperative coma combined with right internal carotid artery ophthalmic segment aneurysm with irregular aneurysm morphology,stent-assisted coil embolization was performed in one stage,and no increased bleeding was seen on postoperative review of cranial CT,and the patient was still comatose 4 days after surgery,and the family gave up treatment.The remaining patients had a postoperative review

关 键 词：小脑后下动脉动脉瘤 血管内治疗 载瘤动脉闭塞 液态栓塞剂 弹簧圈 

分 类 号：R732.21[医药卫生—肿瘤]