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目的探讨血管内治疗颅内大型或巨大型动脉瘤的疗效和长期血管造影随访结果。方法回顾性分析72例颅内大型或巨大型动脉瘤血管内治疗患者的临床资料,其中单纯弹簧圈栓塞30例,支架辅助弹簧圈栓塞14例,覆膜支架治疗15例,载瘤动脉闭塞术13例。结果单纯弹簧圈完全栓塞10例,支架辅助弹簧圈完全栓塞7例,覆膜支架11例,载瘤动脉闭塞13例,总术后即刻完全栓塞率达到56.9%;单纯弹簧圈近完全栓塞17例,支架辅助弹簧圈近完全栓塞6例,覆膜支架4例,总术后即刻近完全栓塞率37.5%;单纯弹簧圈不完全栓塞3例,支架辅助弹簧圈不完全栓塞1例,总术后即刻不完全栓塞率5.6%。随访6~72个月,平均随访24.2个月,所有患者无再出血。围手术期总的并发症率为9.7%,无死亡病例。不同血管内治疗方法对动脉瘤复发率的比较发现,单纯弹簧圈栓塞治疗比其他治疗方法治疗动脉瘤患者复发率高。总的复发率是23.6%。再次用血管内成功治疗14例复发动脉瘤。结论血管内介入治疗颅内大型或巨大型动脉瘤安全有效,远期复发率较高,应加强随访观察。根据动脉瘤部位及形态特点,合理采用相应的血管内介入治疗可有助于提高临床治疗效果,降低复发率。
Objective To investigate the efficacy of endovascular treatment of large or large intracranial aneurysms and follow-up of long-term angiography. Methods The clinical data of 72 patients with endovascular treatment of large or large intracranial aneurysms were retrospectively analyzed. Among them, 30 cases were treated with coil embolization alone, 14 cases were treated with stent-assisted coil embolization, 15 cases were treated with stent-graft, 13 cases. Results The complete coil embolization was performed in 10 cases. The stent-assisted coil was completely embolized in 7 cases. The stent graft in 11 cases and the tumor-bearing artery occluded in 13 cases. The complete embolization rate was 56.9% , Stent-assisted coil nearly complete embolization in 6 cases, 4 cases of stent-graft, immediate complete immediate embolization rate of 37.5%; simple coil incomplete embolization in 3 cases, stent assisted coil incomplete embolization in 1 case, total postoperative Immediately incomplete embolism rate of 5.6%. All patients were followed up for 6 to 72 months with an average follow-up of 24.2 months. All patients had no further bleeding. The overall perioperative complication rate was 9.7% with no deaths. Different endovascular treatment of aneurysm recurrence rate comparison found that simple coil embolization than other treatment of aneurysms in patients with high recurrence rate. The overall recurrence rate was 23.6%. Again with the successful treatment of vascular recurrence of 14 cases of aneurysms. Conclusion Intravascular interventional treatment of large or large intracranial aneurysms is safe and effective, and the long-term recurrence rate is high. Follow-up observation should be strengthened. According to the aneurysm site and morphological characteristics, the appropriate use of appropriate endovascular intervention can help improve the clinical treatment and reduce the recurrence rate.