Study on Clinical Efficacy and Safety of Endovascular Embolization of Ruptured Tiny Intracranial Aneurysms

doi:10.3969/j.issn.1673-5765.2017.07.005

Abstract

Abstract:

Objective To explore the key technique of endovascular embolization of ruptured tiny intracranial aneurysms, and evaluate the clinical efficacy and safety of this treatment. Methods A retrospective analysis of clinical data of patients with subarachnoid hemorrhage was performed to rupture tiny intracranial aneurysm which was treated by endovascular embolization in Yunfu People’s Hospital during April, 2014 and October 2016, and to evaluate the clinical efficacy, intraoperative complications and the prognosis. Results All 23 patients were treated with endovascular coil embolization under the general anesthesia. Among which, 17 of them were only with coil and 6 were with stent-assisted embolization. There were complete embolization in 19 cases (82.61%), aneurysm neck residue in 4 cases (17.39%) and all parent arteries were normal. Aneurysm were followed up for 6-30 months, and no bleeding recurred was found. The parent artery in one (4.35%) case was occluded by a bit of protruding coil and restored to normal after planting Enterprise stent. One (4.35%) with residual aneurysm neck recurred after 1 year and was successfully treated with stent-assisted endovascular embolization. Among 23 patients, the mRS scale scores in 21 cases were 0 at 6 months after procedure, and 2 cases were 2. Conclusion Endovascular embolization for the treatment of ruptured tiny intracranial aneurysms is safe and effective, and the result of short-term follow-up is good.

Key words: Aneurysm; Rupture; Subarachnoid hemorrhage; Endovascular; Embolization

摘要：

目的探讨介入栓塞颅内破裂微小动脉瘤的技术要点，评价其临床疗效和安全性。方法回顾性分析2014年4月-2016年10月云浮市人民医院因微小颅内动脉瘤破裂致蛛网膜下腔出血而行介入栓塞治疗患者的临床资料，评价栓塞治疗的临床疗效、手术并发症及患者预后情况。结果研究共纳入23例微小颅内动脉瘤破裂患者，均在全身麻醉下采用弹簧圈栓塞治疗，其中17例采用单纯弹簧圈栓塞，6例采用支架辅助治疗。致密栓塞19例（82.61%），4例（17.39%）瘤颈残余。所有患者载瘤动脉均通畅，术中无动脉瘤破裂出血，1例（4.35%）术中发生载瘤动脉狭窄闭塞，置入支架后载瘤动脉恢复通畅。术后6～30个月DSA随访均无再出血。1例（4.35%）瘤颈残余患者1年后出现瘤颈部动脉瘤复发，给予支架辅助栓塞治疗。23例患者术后6个月时改良Rankin量表（modified Rankin Scale，mRS）评分0分共21例，2分有2例。结论介入栓塞技术治疗颅内破裂微小动脉瘤是一种安全、有效的治疗手段，术后治疗效果良好。

关键词: 动脉瘤; 破裂; 蛛网膜下腔出血; 介入; 栓塞

WU Zhi-Lin, ZHANG Jin-Zhao, HU Shi-Feng, et al.. Study on Clinical Efficacy and Safety of Endovascular Embolization of Ruptured Tiny Intracranial Aneurysms[J]. Chinese Journal of Stroke, 2017, 12(07): 588-591.

吴志林，张锦钊，胡世峰，吴鉴洲，黄金培. 颅内破裂微小动脉瘤介入栓塞术临床疗效和安全性研究[J]. 中国卒中杂志, 2017, 12(07): 588-591.

References

1 Iskandar A，Nepper-Rasmussen J. Endovascular

treatment of very small intracranial aneurysms[J].

Interv Neuroradiol，2011，17(3)：299-305.

2 Sluzewski M，Bosch JA，Van Rooij WJ，et al. Rupture

of Intracranial aneurysms during treatment with

Guglielmi Detachable coils：incidence，outcome，and

risk factors[J]. J Neurosurg，2001，94(2)：238-240.

3 Cook NF. Emergency care of the patient with

subarachnoid haemorrhage[J]. Br J Nurs，2008，17(10)：

624-629.

4 Van Rooij WJ，Keeren GJ，Peluso JP，et al. Clinical

and angiographic results of coiling of 196 very small

（≤3 cm）intracranial aneurysms[J]. AJNR Am J

Neuroradiol，2009，30(4)：835-839.

5 Ioannidis I，Lalloo S，Corkill R，et al. Endovascular

treatment of very small intracranial aneurysms[J]. J

Neurosurg，2010，112(3)：55l-556.

6 Gil A，Vega P，Murias E，et al. Balloon-assisted

extrasaccular coil embolization technique for the

treatment of very small cerebral aneurysms[J]. J

Neurosurg，2010，112(3)：585-588.

7 袁金龙，方兴根，李真保，等. 血管内治疗胚胎型后交

通动脉破裂动脉瘤的疗效分析[J]. 中国脑血管病杂志，

2016，13(10)：535-539.

8 汪国胜，刘彬，钟平. 丁苯酞对后循环脑梗死患者NIHSS

评分mRS评分及Barthel指数的影响[J]. 医药导报，2015，

34(9)：1189-1191.

9 Van Rooij WJ，Sluzewski M，Beute GN，et al.

Procedural complications of coiling of ruptured

intracranial aneurysms：incidence and risk factors in a

consecutive series of 681 patients [J]. Am J Neuroradiol，

2006，27(7)：1498-1501.

10 Toyoda K，Tsutsumi K，Hirao T，et al. Ruptured

intracranial aneurysms in pediatric polyarteritis nodosa：

case report [J]. Neurol Med Chir (Tokyo)，2012，52(12)：

928- 932.

11 Dima S，Scheau C，Stefanescu F，et al. Endovascular

minimally invasive treatment of the intracranial

aneurysms：first 124 cases [J]. J Med Life，2012，5(3)：

360-366.

12 郝小可，史继新. 蛛网膜下腔出血后早期脑损伤机制研

究进展[J]. 医学研究生学报，2015，7：767-770.

13 Wei M，Ren H，Yin L. The combinational use of dual

microcatheter technique and new hypersoft helical coil

for endovascular treatment of tiny intracranial aneurysm

with difficult geometry [J]. Interv Neuroradiol. 2016，

22(1)：18-25.

14 Anokwute MC，Braca JA，Bohnstedt B，et al.

Endovascular treatment of ruptured tiny (≤3 mm)

intracranial aneurysms in the setting of subarachnoid

hemorrhage：A case series of 20 patients and literature

review[J]. J Clin Neurosci，2017，40：52-56.

15 Zheng Y，Song Y，Liu D，et al. Stent-assisted coiling

embolization of tiny，wide-necked intracranial

aneurysms[J]. Acta Neurochir (Wien)，2017，159(1)：93-100.

16 Nguyen TN，Raymond J，Guilbert F，et al. Association

of endovascular therapy of very small ruptured

aneurysms with higher rates of procedure-related rupture

[J]. J Neurosurg，2008，108(6)：1088-1092.

17 Zang PZ，Liang CS，Shi Q. Endovascular embolization

of very small cerebral aneurysms[J]. Neurol India，2010，

58(4)：576-580.

18 黄青海，聂景浩，吕楠，等. 支架半释放技术辅助弹簧圈

栓塞治疗破裂的颅内微小动脉瘤[J]. 中国临床神经外科

杂志，2013，18(6)：325-327.

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