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颅内动脉瘤(AN)破裂是自发性蛛网膜下腔出血的最重要的原因,Hunt-Hess Ⅲ～IV级患者通常病情危重,再出血、脑血管痉挛等并发症发生率、致残率和死亡率均较高,预后欠佳。近年来,急性期血管内栓塞治疗普遍开展,对预防再出血、预防和改善脑血管痉挛、提高患者生存率、降低致残率做出了积极的贡献,改善了该类患者的预后。一般认为,除了动脉瘤过小而无法放入微弹簧圈,或位于血管末梢微导管无法到达者需手术夹闭外,绝大多数动脉瘤适用血管内介入治疗。本文就Hunt-Hess Ⅲ～IV级患者的急性期血管内治疗的临床应用、围栓塞期处理、预后等作一综述。
Intracranial aneurysm (AN) rupture is the most important cause of spontaneous subarachnoid hemorrhage, Hunt-Hess III-IV patients are generally critically ill, rebleeding, cerebral vasospasm and other complications, the rate of disability and Mortality is high, poor prognosis. In recent years, the treatment of acute endovascular embolism has been carried out universally, and it has made a positive contribution to the prevention of rebleeding, prevention and improvement of cerebral vasospasm, improvement of patient survival and reduction of disability, and has improved the prognosis of such patients. Is generally believed that, in addition to aneurysm is too small to fit into the micro-coil, or located in the distal end of the microcatheter can not be reached by surgery, the vast majority of endovascular interventional endovascular treatment. This article summarizes the clinical application of acute endovascular treatment of patients with Hunt-Hess Ⅲ ~ IV grade, the treatment of peripheral embolism, and prognosis.