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目的 探讨可脱性弹簧圈血管内栓塞治疗颅内动脉瘤的效果及技术要点。方法 对 1 2 6例颅内动脉瘤应用微导管技术 ,在数字减影血管造影 (DSA)监视下行血管内栓塞治疗 ,其中 85例 90个动脉瘤用机械式可脱性弹簧圈 (MDS)栓塞 ,41例 42个动脉瘤用电解式可脱性弹簧圈 (GDC)栓塞。结果 成功栓塞 1 2 6例 1 3 2个动脉瘤 ,1 2 3例痊愈 ,3例死亡。1 0 0 %栓塞 1 2 4个 ,95%栓塞 6个 ,90 %栓塞 2个。并发动脉瘤破裂 4例 ,并发脑梗死 2例 ,其中 1例痊愈 ,1例死亡 ;1例微弹簧末端逸出并顽固性脑血管痉挛致死亡。 2例复发者再予GDC栓塞而治愈。结论 血管内栓塞治疗颅内动脉瘤是一种比较安全、可靠、有效的治疗手段 ,但动脉硬化明显 ,导管到位困难者及术前呼吸、循环功能衰竭者不宜行血管内治疗。动脉瘤较大者 ,术后复发率高 ;术前反复蛛网膜下腔出血者 ,术中动脉瘤破裂的可能性较大。
Objective To investigate the effect and technical points of intracranial arterial embolization with detachable coil. Methods One hundred and sixty-six patients with intracranial aneurysms were treated with endovascular embolization with digital subtraction angiography (DSA). One hundred and eighty aneurysms were treated with mechanical detachable coil (MDS) embolization Forty-two patients with 42 aneurysms were electroplated with an electrovapable detachable coil (GDC). Results Successful embolization of 126 cases of 122 aneurysms, 123 cases recovered, 3 patients died. One hundred and ten of 104 were embolized, six of 95% embolized and two of 90% embolized. 4 cases complicated with rupture of aneurysm and 2 cases complicated by cerebral infarction. Among them, 1 case recovered and 1 case died. One case of micro-spring tip escaped and intractable cerebral vasospasm resulted in death. Two patients relapsed were treated with GDC and cured. Conclusion Endovascular embolization is a safe, reliable and effective treatment for intracranial aneurysms. However, it is not advisable to use endovascular therapy because of obvious atherosclerosis, difficulty of catheterization and preoperative respiration and circulatory failure. Aneurysm larger, high recurrence rate; preoperative repeated subarachnoid hemorrhage, intraoperative aneurysm rupture is more likely.