摘要
目的:探讨破裂大脑中动脉动脉瘤患者行血管内治疗的安全性和有效性。方法:回顾性分析2010年1月至2018年12月宁夏医科大学总医院神经外科收治的52例破裂大脑中动脉动脉瘤患者的临床资料。52例(共52个动脉瘤)患者均采取血管内治疗,其中使用单微导管弹簧圈栓塞17例、双微导管弹簧圈栓塞14例、支架辅助弹簧圈栓塞21例。术后即刻行数字减影血管造影(DSA)复查,其即刻栓塞程度均采用Raymond分级评估。出院后所有患者均行影像学随访,预后评估采用改良Rankin量表评分(mRS)。结果:52例患者的52个动脉瘤中,1个动脉瘤术中破裂后转为开颅手术夹闭,余51个动脉瘤均成功行血管内治疗。51个动脉瘤的术后即刻Raymond分级Ⅰ级33个、Ⅱ级15个、Ⅲ级3个。其中术中1例支架辅助弹簧圈栓塞的患者出现支架内血栓形成,对症治疗后,效果良好,无遗留神经功能缺损症状。52例患者的随访时间为(13.4±3.1)个月(2~48个月),其中预后良好46例(88.5%)(mRS 0~2分),预后不良6例(11.5%)(其中mRS 3分3例、4分2例、5分1例)。共有46例患者行DSA复查,其中3例复发,1例原动脉瘤囊部分再通,遂行二次栓塞术,其即刻栓塞程度达到RaymondⅠ级;1例二次栓塞因微导管无法到位,观察1年后动脉瘤愈合;1例瘤颈部残留和首次栓塞后无变化,继续随访观察。结论:血管内治疗破裂大脑中动脉动脉瘤的临床效果和影像学随访结果良好,但其安全性和有效性仍需更大样本量和更长时间的随访结果来证实。
Objective To explore the safety and efficacy of endovascular treatment in patients with ruptured middle cerebral artery(MCA)aneurysms.Methods A retrospective analysis was conducted on the clinical data of 52 patients with ruptured MCA aneurysms admitted to Department of Neurosurgery,Ningxia Medical University General Hospital from January 2010 to December 2018.All 52 patients(total 52 aneurysms)underwent endovascular treatment.Among them,single-microcatheter coiling was performed in 17 cases,double-microcatheter assisted coiling in 14 and stent-assisted coiling in 21.Digital subtraction angiography(DSA)was performed immediately after endovascular treatment.The immediate embolization degree and postoperative DSA follow-up were evaluated by Raymond-Roy occlusion classification.All patients underwent imaging follow-up after discharge.The patient’s outcome was evaluated based on the modified Rankin scale(mRS).Results Of the 52 patients with 52 aneurysms,1 had rupture of aneurysm and turned to craniotomy and clipping of aneurysm,and the remaining 51 underwent successful endovascular therapy.Postoperative grading results of 51 aneurysms based on Raymond-Roy occlusion classification were classⅠin 33 cases,classⅡin 15,and classⅢin 3.One case of stent-assisted coil embolization developed intraoperative stent thrombosis,which had good outcome without sequela following symptomatic treatment.The follow-up time after discharge of 52 patients was 13.4±3.1 months(2 to 48 months),of which 46 cases(88.5%)reported good outcome(mRS:0-2),and 6 cases(11.5%)had poor outcome(mRS of 3 in 3 cases,mRS of 4 in 2,mRS of 5 in 1).A total of 46 patients were reviewed with DSA,of which 3 relapsed.One case had partial recanalization of the primary aneurysmal sac,underwent a second embolization,and the degree of immediate embolization reached Raymond-Roy class I level.In 1 patient,microcatheter could not be in place during the second embolization,and the aneurysm disappeared after 1 year of observation.One case had residual of aneurysmal
作者
万定
黄德俊
杨振兴
冯进
孙涛
Wan Ding;Huang Dejun;Yang Zhenxing;Feng Jin;Sun Tao(Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第7期698-702,共5页
Chinese Journal of Neurosurgery
基金
宁夏回族自治区重点研发计划项目(2018YBZD0034)。
关键词
颅内动脉瘤
大脑中动脉
栓塞
治疗性
治疗结果
Intracranial aneurysm
Middle cerebral artery
Embolization,therapeutic
Treatment outcome
