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【目的】探讨大型和巨大型颅内动脉瘤血管内治疗方法的选择并对结果进行分析。【方法】对16例经DSA确诊为大型和巨大型颅内动脉瘤进行了经皮穿刺血管内治疗,其中椎动脉瘤2例,基底动脉瘤4例,后交通动脉瘤1例,眼动脉瘤2例,颈动脉海绵窦段动脉瘤7例,分别采用了球囊,游离弹簧圈,MDS-N(机械解脱弹簧圈),GDC水解弹簧圈,Neuroform支架辅助水解弹簧圈栓塞技术。【结果】游离弹簧圈致密填塞6例,6例95%以上填塞,2例获90%填塞。2例行球囊载瘤动脉栓塞术。支架结合GDC或水解弹簧圈致密填塞4例,另4例应用水解弹簧圈有2例获致密填塞,2例获95%栓塞。除1例因术中游离弹簧圈脱入大脑中动脉术后出现轻偏瘫,其余病例临床症状消失或好转,8例随访2个月至3年,无再出血或症状加重。【结论】大型和巨大型颅内动脉瘤血管内治疗能获得满意的临床结果。
【Objective】 To explore the methods of endovascular treatment of large and huge intracranial aneurysms and to analyze the results. 【Methods】 Twenty-six patients with DSA diagnosed with large and huge intracranial aneurysms were treated with percutaneous transluminal angioplasty. There were 2 cases of vertebral aneurysm, 4 cases of basilar artery aneurysm, 1 case of posterior communicating artery aneurysm, 1 case of ocular aneurysm, 2 cases and 7 cases of carotid cavernous sinus aneurysm. Balloon, free coil, MDS-N (mechanical release coil), GDC hydro-coil and Neuroform stent-assisted coil embolization were used respectively. 【Results】 There were 6 cases of free coil spring packing, 6 cases of over 95% packing and 2 cases of 90% packing. 2 routine balloon-bearing artery embolization. The stent was combined with GDC or Hydrolytic Spring Compression packing in 4 cases. In the other 4 cases, 2 cases were densely packed with Hydrolyzed coil and 95% embolized in 2 cases. Except for one case with slight hemiparesis due to detachment of the intraoperative free coil into the middle cerebral artery, the clinical symptoms disappeared or improved in the remaining cases. Eight patients were followed up for 2 months to 3 years with no further bleeding or aggravation of symptoms. 【Conclusion】 Endovascular treatment of large and huge intracranial aneurysms can achieve satisfactory clinical results.