急性破裂性颅内动脉瘤早期血管内栓塞治疗  

Early endovascular embolization of acutely ruptured intracranial aneurysms

作　　者：谭显西[1] 钟鸣[1] 李则群[1] 林晨[1] 鲁祥和[1] 

机构地区：[1]温州医学院附属第一医院神经外科,325000

出　　处：《中国脑血管病杂志》2004年第5期204-206,共3页Chinese Journal of Cerebrovascular Diseases

基　　金：国家"十五"科技攻关项目(2001BA703B18)

摘　　要：目的探讨急性破裂性颅内动脉瘤早期血管内栓塞治疗的效果.方法对100例急性破裂性颅内动脉瘤患者,早期采用经股或经颈动脉穿刺行全脑选择性血管造影术,应用电解可脱微弹簧圈进行动脉瘤囊内栓塞.结果 100%动脉瘤腔闭塞的45个,95%闭塞的39个,90%闭塞的18个.G1asgow预后评分:I级86例,Ⅱ级5例,Ⅲ～Ⅳ级4例,V级5例.1例椎动脉瘤栓塞后8 h,动脉瘤再次破裂出血死亡.1例栓塞术后36 h再出血,再次行开颅动脉瘤夹闭术.随访0.5～2年无再出血.结论早期动脉瘤囊内栓塞,是治疗急性破裂性颅内动脉瘤较理想的方法,栓塞后早期再出血可能与瘤颈破裂性动脉瘤及夹层囊性动脉瘤有关.Objective To study the effect of early endovascular embolization of acutely ruptured in tracranial aneurysms with micro-coils. Methods 100 cases were treated with micro-coils (GDC10, GDC18, EDC, MATRIX) to embolize the aneurysmal sac via carotid and femoral artery approach. In 35 cases the aneurysms were located on AcoA, 12 cases on MCA, 44 cases on PcoA, 4 cases on BVA and Teases on VA. 2 a neurysms were found in each of 2 cases. 56 cases were classified as Hess & Hunt Grade Ⅱ, 30 as Grade Ⅲ, 11 as Grade Ⅳ and 3 as Grade Ⅴ. The diameters of 90 aneurysms were less than 10mm, more than 10mm in 10 a neurysms. Results The sac of 43 aneurysms were completely occluded, 39 aneurysms were occluded to 95% and 15 aneurysms were occluded to 90%. 86 cases were classified as Glasgow Outcome Score gradeⅠ. 5 cases as grade Ⅱ, 4 cases as grade Ⅲ-Ⅳ, 5 cases as grade Ⅴ. 1 case of BA aneurysm died 8 hours after embolization because of re-bleeding. In addition, 1 case of aneurysm re-bled 36 hours after embolization, and then operation was done and the aneurysm was clipped. No re-bleeding happened during 0. 5-2 years following up. Conclusion Early endovascular embolization is a good choice for ruptured intracranial aneurysms. The dissecting a neurysms and aneurysms that have ruptured in their necks are more prone to re-bleed after embolization.

关 键 词：急性破裂性颅内动脉瘤 早期 血管内栓塞 治疗 预后 

分 类 号：R739.4[医药卫生—肿瘤]