摘要
目的探讨超早期支架辅助弹簧圈栓塞颅内破裂宽颈动脉瘤的安全性和临床效果。方法回顾性分析收治的26例破裂颅内宽颈动脉瘤患者的临床资料,所有患者于急诊超早期行支架辅助下弹簧圈栓塞术。术前按Hunt-Hess分级,Ⅰ~Ⅱ级16例,Ⅲ级8例,Ⅳ级2例。对患者即时栓塞效果、围手术期并发症、以及90 d临床预后情况进行分析。结果 26例颅内宽颈动脉瘤患者支架均完全释放(100%),术后Raymond I级栓塞23例(88.5%),Raymond l I级栓塞3例(11.5%),1例前交通动脉瘤患者在栓塞过程中支架内形成血栓,给予盐酸替罗非班氯化钠注射液治疗后血栓消失,术中动脉瘤破裂1例,予以紧急填塞止血后复查CT出血增加,但经持续腰大池引流后恢复良好,经90 d随访,疗效良好者(m RS评分0~2分)23例,疗效不良者(m RS评分3~6分)2例,死亡1例。良好率为88.5%。结论超早期支架辅助栓塞治疗破裂颅内动脉瘤是安全有效的,可避免动脉瘤再次破裂出血,提高动脉瘤的致密栓塞率,降低复发率,对降低病死率及致残率具有重要意义。
Objective To investigate the safety and clinical efficacy of ultra-early stent-assisted coil embolization in treatment of rupture intracranial wide-necked aneurysms.Methods The clinical data about 26 patients with rupture intracranial wide-necked aneurysms who were treated in our hospital from March 2014 to March 2017 were retrospectively analyzed.All the patients were treated by stent-assisted coil embolization at the early stage of emergency.According to preoperative Hunt-Hess classification,there were 16 cases of gradeⅠ~Ⅱ,8 cases of gradeⅢgrade and 2 cases of gradeⅣ.The immediate embolism effects,perioperative complications,clinical prognosis after 90-day follow up were analyzed.Results Twenty-six patients with wide-necked intracranial aneurysm were completely released(100%),there were 23 cases(88.5%)of Raymond grade I embolism,3 cases(11.5%)of Raymond grade lI embolism,moreover,the thrombus was formed inside the stent during embolization in one patient with anterior communicating aneurysm,and the thrombus was disappeared after treated by tirofiban sodium chloride injection.In addition there was 1 case of intraoperative aneurysm rupture,but the patient recovered well after continuous lumbar drainage.After 90-day follow up,excellent and good effects were in 23 patients(mRS score 0-2 points),bad effects in 2 patients(mRS score 3-6 points),and one patient died,with excellent and good rate being 88%.Conclusion The ultra-early stent-assisted embolization in treatment of rupture intracranial aneurysms is safe and effective,which can avoid aneurysm rupture again,improve the aneurysm density embolization rate and reduce the relapse rate,which plays an important role in decreasing the mortality and disability rate of patients.
作者
刘秋成
廖华
高峰
贾丽
郑欣
毕艳华
陈培培
LIU Qiucheng;LIAO Hua;GAO Feng(Department of Emergency,Northern China Petroleum General Hospital,Hebei,Renqiu 062552,China)
出处
《河北医药》
CAS
2018年第5期702-705,共4页
Hebei Medical Journal
关键词
颅内动脉瘤
支架辅助栓塞
超早期治疗
急诊
宽颈
intracranial aneurysms
stent assisted embolization
ultra early stage treatment
emergency
wide neck
