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目的 评价经血管电解脱弹簧 (GDC)栓塞颅内动脉瘤的临床效果。方法 应用GDC分别采用“蚕茧”填塞技术和“蚕食”填塞技术 ,对 81例 84枚颅内动脉瘤予以动脉瘤腔栓塞 ,其中动脉瘤性蛛网膜下腔出血者 6 3例 ,未破裂者 18例。 45例在术后 3个月或 6个月作随访脑血管造影。结果 74例 77枚动脉瘤GDC栓塞成功 ,7例手术失败。 77枚动脉瘤中 ,42例获完全闭塞 ,2 2例获大部闭塞 ,13例获部分闭塞。闭塞程度与动脉瘤腔大小、动脉瘤颈宽度有关 ,在巨大动脉瘤和宽颈动脉瘤 (瘤体∶瘤颈 <2 ) ,较难完全闭塞。随访脑血管造影中 ,7例不完全闭塞患者显示原残腔扩大。 74例中发生术中动脉瘤再破裂出血 4例 ,其中 3例继续GDC栓塞后愈合 ,1例术后 1周死亡 ;术中血栓形成 3例 ,2例行局部动脉内溶栓后完全康复 ,1例永久性轻度单肢瘫。结论 GDC栓塞术选择性应用于颅内动脉瘤患者是安全的 ,定期随访血管造影评价栓塞效果是必要的 ,经验丰富的操作医师可使并发症发生率降低到最底点
Objective To evaluate the clinical effect of transcatheter arterial aneurysm (EAC) embolization by electro-vascular debridement (GDC). Methods 81 cases of 84 intracranial aneurysms were treated by GDC with “silkworm cocoon” packing technique and “encroachment” packing technique respectively, of which aneurysm subarachnoid hemorrhage was performed in 63 cases without rupture example. 45 cases were followed up for cerebrovascular angiography at 3 months or 6 months after operation. Results 74 cases of 77 aneurysms GDC embolization was successful, 7 cases failed. Of 77 aneurysms, 42 were completely occluded, 22 were mostly occluded, and 13 were partially occluded. The degree of occlusion is related to aneurysm size and aneurysmal neck width. It is more difficult to completely occlude in giant aneurysms and wide-necked aneurysms (tumor: tumor neck <2). In follow-up cerebrovascular angiography, seven patients with incomplete occlusion showed an enlarged residual cavity. In 74 cases, intraoperative aneurysm rupture occurred in 4 cases, of which 3 cases continued to heal after GDC embolization, 1 case died 1 week after surgery; 3 cases of intraoperative thrombosis, 2 cases of local arterial thrombolysis after complete recovery, A case of permanent mild single limbs paralysis. Conclusion The selective application of GDC embolization in patients with intracranial aneurysm is safe. It is necessary to evaluate the embolization effect by regular follow-up angiography. Experienced surgeons can reduce the complication rate to the lowest point