俞国松 阮善平 胡小铭 赵志新 泮双军 杨松

[摘要] 目的 探討介入栓塞术治疗颅内破裂前循环微小动脉瘤的临床疗效和安全性。 方法 回顾性分析2018年2月至2019年3月在我院应用介入栓塞术治疗的破裂前循环微小动脉瘤患者14例的临床资料，应用术后即刻造影后Raymond分级、随访复发率及改良Rankin量表评分评估手术疗效，以围术期手术相关并发症发生率及随访复查载瘤动脉狭窄、弹簧圈脱出发生率评价手术安全性。 结果 14例患者中，应用单纯弹簧圈栓塞12例，支架辅助栓塞1例;术后即刻造影示致密栓塞9例（64.3%），瘤颈残留4例（28.6%），手术失败1例;患者围术期均未发生手术相关并发症;术后3～6个月随访结果显示，完全闭塞11例、弹簧圈袢部分脱出至载瘤动脉1例、瘤颈残留1例。患者术后6个月mRS评分均为0～1分。 结论 颅内前循环破裂微小动脉瘤患者应用介入栓塞术治疗安全有效。

[关键词] 破裂;微小;动脉瘤;介入

[中图分类号] R743.4          [文献标识码] B          [文章编号] 1673-9701（2021）07-0066-04

The clinical efficacy and safety of interventional embolization in the treatment of intracranial ruptured anterior circulation microaneurysms

YU Guosong1   RUAN Shanping1   HU Xiaoming1   ZHAO Zhixin1   PAN Shuangjun1   YANG Song2

1.Department of Neurosurgery， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Taizhou  317000， China; 2.Department of Radiology， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Taizhou   317000， China

[Abstract] Objective To explore the clinical efficacy and safety of interventional embolization in the treatment of intracranial ruptured anterior circulation microaneurysms. Methods The clinical data of 14 patients with ruptured anterior circulation microaneurysms treated by interventional embolization in our hospital from February 2018 to March 2019 were analyzed retrospectively. The curative effect of the operation was evaluated by Raymond grading after immediate postoperative angiography， the recurrence rate during follow-up and scores of modified Rankin scale （mRS）. The safety of the operation was assessed by the incidence rate of perioperative operation-related complications and the incidence rate of parent artery stenosis and spring coil prolapse during follow-up and reexamination. Results Among the 14 cases， 12 cases were embolized with spring coil alone， and 1 case was embolized by the assistance of stent. Immediate postoperative angiography showed that 9 cases had pyknotic embolization（64.3%）， 4 cases had residual aneurysm neck （28.6%） and the operation of 1 case had failed. There were no operation-related complications during the perioperative period. Follow-up at 3 and 6 months after operation showed that 11 cases had complete occlusion， 1 case had partial prolapse of spring coil loop， and 1 case still had residual aneurysm neck. The mRS scores of the 6 months after the operation kept being 0-1 point. Conclusion Interventional embolization treatment is safe and effective for intracranial ruptured anterior circulation microaneurysms patient.

[Key words] Rupture; Micro; Aneurysm; Interventional

在2005年发表的国际蛛网膜下动脉瘤研究（International sub-arachnoid aneurysm trial，ISAT）报告中已证实，介入栓塞治疗破裂动脉瘤的效果优于开颅夹闭，但该试验中并未评估瘤体直径≤3 mm的动脉瘤的治疗问题[1]。临床中多将瘤体最大直径≤3 mm的这一类动脉瘤统称为颅内微小动脉瘤，此类动脉瘤因瘤腔小、壁薄，具有手术难度大、风险高等特点[2-4]。随着介入材料和技术的不断发展，介入治疗颅内破裂微小动脉瘤越来越被临床工作者所接受，其相关并发症也越来越少，但依然面临微导管到位困难、微导管不稳定、弹簧圈不稳定、术中易破裂等挑战。……