球囊辅助弹簧圈在血管内栓塞颅内动脉瘤中的应用和中长期随访

摘要

目的 探讨球囊辅助弹簧圈栓塞(balloon-assisted coiling embolization,BACE)颅内动脉瘤的应用价值和中长期随访结果.方法 回顾性分析2006年至2011年48例使用新一代BACE治疗的颅内动脉瘤患者,其中38例破裂出血.42例宽颈动脉瘤,7例瘤颈＞ 4 mm,37例体颈比≤ 1.5,16例最大径为5 ～ 7 mm,25例 3 ～ 5 mm,7例小于3 mm.术后3、12、24个月复查脑血管造影.结果 BACE成功栓塞颅内动脉瘤44例,其余4例使用了支架;完全栓塞39例,次全栓塞9例,术后48 h内2例出现缺血事件,随访发现3例无症状性脑梗死.43例至少造影随访1次,36例造影随访超过24个月,完全栓塞病例中无一例再通,次全栓塞9例中2例稳定,2例进行性血栓形成,5例再通,其中3例进行了支架辅助下弹簧圈栓塞.无再出血病例.结论 BACE治疗最大径小于7 mm的颅内动脉瘤有效、安全,但宽颈动脉瘤有时需要支架辅助弹簧圈栓塞.%Objective To discuss the application of balloon-assisted coiling embolization ( BACE ) in performing endovascular treatment of intracranial aneurysms and to analyze its mid-to-long term effectiveness. Methods A total of 48 patients with intracranial aneurysms, encountered in the hospital during the period from 2006 to 2011, were enrolled in this study. Most up-to-date BACE technique was employed in performing endovascular treatment of intracranial aneurysms in all the patients. Of the total 48 cases, acute subarachnoid hemorrhage was found in 38. Of the total 48 patients, wide-neck aneurysm was seen in 42, neck size > 4 mm in 7, dome-to-neck ratio ^ 1.5 in 37. The maximum dimension of the aneurysm was 5 - 7 mm in 16 cases, 3 - 5 mm in 25 cases and < 3 mm in 7 cases. Cerebral angiography re-examination was carried out at 3, 12 and 24 months after the treatment. The results were analyzed. Results BACE was successfully accomplished in 44 cases, and neuroform stent-assisted coiling embolization was adopted in the remaining 4 cases. Complete occlusion of the aneurysm was obtained in 39 cases, and subtotal occlusion of the aneurysm in 9 cases. Two patients developed ischemic events within 48 hours after the procedure. During the follow-up period, asymptomatic cerebral infarction was detected in 3 patients. At least one angiographic reexamination was carried out in 43 patients. Thirty-six patients were followed up for over 24 months. No re-canalized aneurysm was seen in the 39 patients whose aneurysms had been completely obstructed. Of the nine patients whose aneurysms had been sub-totally occluded, stable condition was seen in 2, progressive thrombosis in 2 and reopen of the aneurysms in 5, among them neuroform stent-assisted coiling embolization had to be employed in 3. No re-bleeding occurred in all cases. Conclusion For the intracranial aneurysms with the maximum dimension < 7 mm, BACE is an effective and safe treatment, but sometimes neuroform stent-assisted coiling embolization may be needed for the wide-necked aneurysms.