大脑前动脉A1段近端动脉瘤血管内治疗:微导管塑形及栓塞策略  

Endovascular treatment of proximal aneurysm of anterior cerebral artery A1 segment: microcatheter shaping and embolization strategy

作　　者：曹侃[1] 梅照军 陈伟[1] 陆新宇[1] 张庆荣 CAO Kan;MEI Zhaojun;CHEN Wei;LU Xinyu;ZHANG Qingrong(Department of Neurosurgery,The Affiliated People's Hospital of Jiangsu University,Zhenjiang 212008,China;不详)

机构地区：[1]江苏大学附属人民医院神经外科,镇江212008 [2]南京大学医学院附属鼓楼医院神经外科

出　　处：《临床神经外科杂志》2025年第1期73-78,共6页Journal of Clinical Neurosurgery

基　　金：镇江“金山英才”高层次领军人才培养计划科研项目(2021-169DT-19)。

摘　　要：目的 探讨血管内治疗(EVT)大脑前动脉A1段近端动脉瘤的安全性和有效性。方法 回顾性分析南京大学医学院附属鼓楼医院神经外科2018年1月—2023年1月行血管内治疗的33例大脑前动脉Al段近端动脉瘤患者的临床资料,所有患者术前均行数字减影血管造影(DSA)检查,了解动脉瘤位置、指向及大小情况,根据DSA结果选择行单纯弹簧圈栓塞或联合支架辅助栓塞,并依据动脉瘤位置、指向等选择微导管塑形方式。所有患者术后即刻行DSA复查,以Raymond分级评估栓塞效果,术后通过DSA或计算机断层扫描血管造影(CTA)分析大脑前动脉A1段近端动脉瘤的血管内治疗效果,改良Rankin量表(mRS)评价预后结果。结果 所有动脉瘤患者血管内治疗均取得成功,术后即刻造影显示,Raymond分级Ⅰ级31例,Ⅱ级2例。XperCT提示未见出血或者破裂动脉瘤患者出血增多。33例患者出院时均未遗留神经功能障碍,随访期间患者无出血缺血事件发生。33例患者术后3~18个月行DSA或者CTA随访,有1例患者出现瘤颈部复发,再次入院行支架植入,未填弹簧圈;临床随访90 d的mRS评分结果为0分32例,1分1例。结论 血管内治疗大脑前动脉A1段近端动脉瘤是一种安全且有效的方法。Objective To investigate the safety and effectiveness of endovascular treatment(EVT)of proximal aneurysm in A1 segment of anterior cerebral artery.Methods The clinical data of 33 patients with proximal aneurysms of Al segment of anterior cerebral artery who received EVT in the Department of Neurosurgery,from January 2018 to January 2023 were retrospectively analyzed.All patients underwent digital subtraction angiography(DSA)before operation to understand the location,direction and size of aneurysms.According to the results of DSA,simple coil embolization or combined with stent-assisted embolization was selected and the microcatheter shaping method was selected according to the location and direction of aneurysms.All patients underwent DSA reexamination immediately after operation and the embolization effect was evaluated by Raymond classification.The EVT effect of proximal A1 segment of anterior cerebral artery aneurysms was analyzed by DSA or computered tomography angiography(CTA)after operation,and the prognosis was evaluated by modified Rankin scale(mRS).Results All patients with aneurysms underwent successful EVT,immediate postoperative angiography showed that 31 cases were Raymond gradeⅠand 2 cases were gradeⅡ.XperCT indicated no new bleeding or increased bleeding in patients with ruptured aneurysms.None of the 33 patients had neurological dysfunction before discharged and no bleeding or ischemia events occurred during follow-up.The 33 patients were followed up by DSA or CTA after surgery,and 1 patient recrudesced and was readmitted to hospital for stent implantation without filling coil.The mRS score following 90 days of clinical follow-up was 0 in 32 cases and 1 in 1 case.Conclusions EVT is a safe and effective method for proximal aneurysm in A1 segment of anterior cerebral artery.

关 键 词：大脑前动脉A1段近端动脉瘤 血管内治疗 微导管 弹簧圈 

分 类 号：R743[医药卫生—神经病学与精神病学]