颅内巨大动脉瘤诱导式栓塞治疗的临床研究(1)
[摘要]目的 评价诱导式栓塞治疗对颅内巨大动脉瘤(GIA)的临床意义。方法 收集2011年1月～2013年7月我院因GIA行介入治疗的20例(20枚)患者，具备完整的临床资料，其中行弹簧圈诱导式栓塞术治疗10例，载瘤动脉闭塞术治疗10例，随访6～24个月，评价术后即刻造影结果及随访造影结果。结果 行弹簧圈诱导式栓塞术的患者术后造影：完全闭塞8例(80%)，大部分闭塞2例(20%)。行动脉闭塞术的患者术后造影：完全闭塞6例(60%)，大部分闭塞2例(20%)，部分闭塞2例(20%)。末次随访造影：行弹簧圈诱导式栓塞术的患者均为完全闭塞；行动脉闭塞术的患者，7例为完全闭塞，1例为大部分闭塞，2例再开放经覆膜支架治疗后转为完全闭塞。结论 弹簧圈诱导式栓塞术后即刻造影结果及随访造影结果均优于载瘤动脉栓塞术。
[关键词]血管内治疗；巨大动脉瘤；诱导式栓塞；载瘤动脉栓塞
[中图分类号] R739.41 [文献标识码] A [文章编号] 1674-4721(2016)12(b)-0052-03
Clinical study of induced embolization in the treatment of giant intracranial aneurysm
ZHANG Zhen-yu JIANG Qiu-hua HUANG Jin-qing
Department of Neurosurgery，People′s Hospital of Ganzhou City in Jiangxi Province，Ganzhou 341000，China
[Abstract]Objective To evaluate the clinical significance of induced embolization in the treatment of giant intracranial aneurysm (GIA).Methods 20 patients undergoing interventional therapy in our hospital from January 2011 to July 2013 were enrolled in this study，which clinical data were obtained from 10 patients who underwent spring coil induced embolization and 10 cases were treated by occlusion of aneurysm.The results were followed up for 6-24 months，the results of immediate angiography and followed-up angiography were evaluated.Results Among postoperative angiography，8 patients (80%) were completely occluded and 2 patients (20%) were most occluded in patients underwent spring coil induced embolization.Among postoperative angiography，6 cases (60%) were completely occluded，2 cases (20%) were most occluded and 2 cases (20%) were partially occluded in patients underwent occlusion of aneurysm.The followed-up angiography was performed that all patients were completely occluded among patients underwent spring coil induced embolization；7 patients with complete occlusion，1 with most occlusion and 2 with re-opening after stent-graft embolization treatment turned to complete occlusion among patients underwent occlusion of aneurysm.Conclusion The results of angiography and followed-up angiography after spring coil induced embolization are better than those of occlusion of aneurysm.
[Key words]Endovascular treatment；Giant aneurysm；Induced embolization；Embolizing aneurysms
顱内巨大动脉瘤(giant intracranial aneurysm，GIA)是指最大直径>25 mm的动脉瘤，发生率较高，占颅内动脉瘤的5%左右，可分为梭形、囊状及夹层3种，多发于50～70岁，位于前循环的约占66.7%(颈内动脉海绵窦段、眼动脉)，位于后循环的约占33.3%(基底动脉分叉处、大脑后动脉)[1]。通常表现为颅内占位性效应、蛛网膜下腔出血、血栓脱落导致的脑梗死等。GIA的自然预后较差，多数动脉瘤会自发破溃，2年死亡率>60%[1]。GIA的保守治疗效果欠佳，传统治疗方式如血管夹闭术、血运重建术致残率及死亡率均较高，分别为26%～35%和15%～21%[2-3]，这与GIA的瘤体巨大、位置特殊，常伴瘤颈宽大、动脉粥样硬化、动脉血栓等因素有关。随着介入技术的发展，血管介入治疗已成为治疗GIA的有效方式，本文旨在探讨弹簧圈诱导式栓塞对治疗GIA的意义。 (张震宇 蒋秋华 黄锦庆)
[关键词]血管内治疗；巨大动脉瘤；诱导式栓塞；载瘤动脉栓塞
[中图分类号] R739.41 [文献标识码] A [文章编号] 1674-4721(2016)12(b)-0052-03
Clinical study of induced embolization in the treatment of giant intracranial aneurysm
ZHANG Zhen-yu JIANG Qiu-hua HUANG Jin-qing
Department of Neurosurgery，People′s Hospital of Ganzhou City in Jiangxi Province，Ganzhou 341000，China
[Abstract]Objective To evaluate the clinical significance of induced embolization in the treatment of giant intracranial aneurysm (GIA).Methods 20 patients undergoing interventional therapy in our hospital from January 2011 to July 2013 were enrolled in this study，which clinical data were obtained from 10 patients who underwent spring coil induced embolization and 10 cases were treated by occlusion of aneurysm.The results were followed up for 6-24 months，the results of immediate angiography and followed-up angiography were evaluated.Results Among postoperative angiography，8 patients (80%) were completely occluded and 2 patients (20%) were most occluded in patients underwent spring coil induced embolization.Among postoperative angiography，6 cases (60%) were completely occluded，2 cases (20%) were most occluded and 2 cases (20%) were partially occluded in patients underwent occlusion of aneurysm.The followed-up angiography was performed that all patients were completely occluded among patients underwent spring coil induced embolization；7 patients with complete occlusion，1 with most occlusion and 2 with re-opening after stent-graft embolization treatment turned to complete occlusion among patients underwent occlusion of aneurysm.Conclusion The results of angiography and followed-up angiography after spring coil induced embolization are better than those of occlusion of aneurysm.
[Key words]Endovascular treatment；Giant aneurysm；Induced embolization；Embolizing aneurysms
顱内巨大动脉瘤(giant intracranial aneurysm，GIA)是指最大直径>25 mm的动脉瘤，发生率较高，占颅内动脉瘤的5%左右，可分为梭形、囊状及夹层3种，多发于50～70岁，位于前循环的约占66.7%(颈内动脉海绵窦段、眼动脉)，位于后循环的约占33.3%(基底动脉分叉处、大脑后动脉)[1]。通常表现为颅内占位性效应、蛛网膜下腔出血、血栓脱落导致的脑梗死等。GIA的自然预后较差，多数动脉瘤会自发破溃，2年死亡率>60%[1]。GIA的保守治疗效果欠佳，传统治疗方式如血管夹闭术、血运重建术致残率及死亡率均较高，分别为26%～35%和15%～21%[2-3]，这与GIA的瘤体巨大、位置特殊，常伴瘤颈宽大、动脉粥样硬化、动脉血栓等因素有关。随着介入技术的发展，血管介入治疗已成为治疗GIA的有效方式，本文旨在探讨弹簧圈诱导式栓塞对治疗GIA的意义。 (张震宇 蒋秋华 黄锦庆)