大规格弹簧圈栓塞术在颅内动脉瘤中的临床疗效探讨

doi:10.3877/cma.j.issn.2095-5782.2017.04.009

中华介入放射学电子杂志 ›› 2017, Vol. 05 ›› Issue (04) : 244 -248. doi: 10.3877/cma.j.issn.2095-5782.2017.04.009

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神经介入

大规格弹簧圈栓塞术在颅内动脉瘤中的临床疗效探讨

薛绛宇¹^,^†(

), 赵同源¹, 蔡栋阳¹, 时伟玉², 李钊硕¹, 张坤¹, 李天晓¹, 贺迎坤¹

^1. 河南省人民医院介入科脑血管病区
^2. 新乡医学院

收稿日期:2017-09-01 出版日期:2017-11-01
通信作者: 薛绛宇
基金资助:
国家自然科学基金(81601583); 国家十三五重点研发计划(2016YFC1300702)

Clinical application and curative effect of large-size coils embolization using in intracranial aneurysms

Jiangyu Xue¹^,^†(), Tongyuan Zhao¹, Dongyang Cai¹, Weiyu Shi², Zhaoshuo Li¹, Kun Zhang¹, Tianxiao Li¹, Yingkun He¹

^1. Cerebrovascular Division of Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou 450003, China

Received:2017-09-01 Published:2017-11-01
Corresponding author: Jiangyu Xue
About author:
Corresponding author: Xue Jiangyu, Email: xueshenyi1@126.com

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目的：

探讨大规格弹簧圈栓塞术在颅内动脉瘤治疗中的安全性、可行性、经济性和有效性。

方法：

回顾性分析2016年1—12月我院使用大规格弹簧圈（第一枚弹簧圈规格明显大于动脉瘤直径的弹簧圈）治疗的颅内动脉瘤患者40例，40枚动脉瘤，术后即刻采用脑血管造影评价所有患者的临床疗效，术后随访6个月后，再次进行脑血管造影以评价疗效。

结果：

40例颅内动脉瘤中破裂动脉瘤患者24例，未破裂动脉瘤患者16例。采用大规格弹簧圈治疗的动脉瘤共40枚，其中单纯弹簧圈栓塞21枚，支架辅助栓塞19枚，栓塞成功率为100%。动脉瘤长径平均值为（6.27±2.76）mm，动脉瘤直径平均值为（5.28±2.27）mm。每个动脉瘤平均使用弹簧圈（3.26±1.48）枚，弹簧圈平均长度为（34.95±27.22）cm，动脉瘤的平均固体填充率为（18.32±6.39）%。40枚动脉瘤术后即刻血管造影显示Raymond分级：Ⅰ级39枚，Ⅱ级1枚，术中未发生动脉瘤破裂出血以及血栓事件。术后6个月所有患者均行全脑血管造影复查，Raymond分级Ⅰ级39枚，Ⅱ级1枚，随访期间无死亡及再出血事件发生。

结论：

大规格弹簧圈栓塞术在颅内动脉瘤栓塞治疗中是安全有效的，其长期疗效有待进一步大样本量去验证。

关键词: 大规格弹簧圈, 支架辅助栓塞, 动脉瘤固体填充率

Objective:

To explore the safety, feasibility, economy and effectiveness of large-size coils embolization.

Methods:

40 consecutive patients with intracranial aneurysms treated with large-size coils (the first coil was obviously larger than the diameter of the aneurysm) from January to December 2016 in our center were analyzed retrospectively. Endovascular coiling treatment detials were analyzed according to the cerebral angiography immediately after treatment.

Results:

A total of 40 aneurysms in 40 patients received endovascular treatment with sith large-size coils, 24 ruptured and 16 unruptured. The mean largest diameter of the aneurysms was (6.27±2.76) mm, the mean diameter of the aneurysms was (5.28±2.27) mm, of which 21 cases were embolized, 19 cases embolized with the assistence of stent. An average of (3.26±1.48) coils with a mean length of (34.95±27.22) cm per aneurysm was used, resulting in a mean packing density of (18.32±6.39) %. The angiography immediately after treatment showed that among the 40 intracranial aneurysms 39 belonged to Raymond grade Ⅰ, 1 belonged to Raymond grade Ⅱ. No procedural aneurysm rupture and thromboembolic events observed during the operation. Follow-up angiography 6 months after the treatment revealed that 39 aneurysms were Raymond grade Ⅰ, 1 aneurysms was Raymond grade Ⅱ. During the follow-up period, no death and re-bleeding events occurred.

Conclusions:

For the treatment of intracranial aneurysms, large-size coils embolization is safe and effective although its long-term results need to be further studied.

Key words: Large-size coils, Stent-assisted embolization, Aneurysm solid filling rate

表1 动脉瘤部位和直径

部位		例数	动脉瘤直径*(mm)	例数
前循环		?	?	?
?	颈内动脉眼段	7	<5	16
?	前交通动脉	10	5～10	21
?	后交通动脉	11	>10	3
?	大脑中动脉	4	?	?
后循环		?	?	?
?	基底动脉顶端	5	?	?
?	椎动脉颅内	3	?	?

表1 动脉瘤部位和直径

部位		例数	动脉瘤直径*(mm)	例数
前循环		?	?	?
?	颈内动脉眼段	7	<5	16
?	前交通动脉	10	5～10	21
?	后交通动脉	11	>10	3
?	大脑中动脉	4	?	?
后循环		?	?	?
?	基底动脉顶端	5	?	?
?	椎动脉颅内	3	?	?

图1 第一枚弹簧圈规格与动脉瘤直径的线性关系图

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[1]	王晓东, 秦兆为. 支架辅助弹簧圈栓塞颅内宽颈破裂动脉瘤的疗效分析[J]. 中华神经创伤外科电子杂志, 2017, 03(06): 335-342.
[2]	陈振, 晋亚洲, 刘朝, 王林玉, 孙晓祯, 郭新宾, 管生. LVIS支架辅助栓塞颅内破裂动脉瘤的有效性和安全性[J]. 中华介入放射学电子杂志, 2019, 07(04): 291-293.

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