CAJ | 학술논문

目的：评价三维旋转DSA作为脑动脉瘤破裂出血患者急诊首选检查的临床价值。方法2010年1月至2012年5月之间共63例患者接受了急诊三维旋转DSA检查，并确诊为脑动脉瘤。根据DSA检查结果对患者计划并实施了血管腔内介入治疗或神经外科手术治疗，将三维旋转DSA结果与血管内治疗或外科治疗的结果进行比较研究，记录和分析患者临床结果、随访结果。结果通过三维旋转DSA检查，在63例患者中发现脑动脉瘤66个并进行了外科夹闭或血管内介入治疗。接受外科手术夹闭的外科组19例患者中，三维DSA结果与外科术中所见吻合；而接受血管内治疗的介入组44例患者（47个动脉瘤）均接受了血管内介入治疗。平均随访时间为10个月，随访中介入组有6例发生并发症。介入组1例患者因微导管插管未到位而致栓塞失败，转入外科组成功进行了动脉瘤夹闭术。外科组技术成功率100．0％，介入组技术成功率97．7％；随访中介入组并发症发生率为13．6％，外科组为0．0％。术后10例外科组和19例介入组患者有CTA或DSA复查资料。本研究随访中没有动脉瘤治疗后再出血的发生。结论三维旋转DSA提供了高质量的多方位图像，有利于脑动脉瘤破裂出血患者治疗方案的制定。基于多学科合作基础的三维旋转DSA技术用于此类患者的急诊首选检查安全有效。
목적：평개삼유선전DSA작위뇌동맥류파렬출혈환자급진수선검사적림상개치。방법2010년1월지2012년5월지간공63례환자접수료급진삼유선전DSA검사，병학진위뇌동맥류。근거DSA검사결과대환자계화병실시료혈관강내개입치료혹신경외과수술치료，장삼유선전DSA결과여혈관내치료혹외과치료적결과진행비교연구，기록화분석환자림상결과、수방결과。결과통과삼유선전DSA검사，재63례환자중발현뇌동맥류66개병진행료외과협폐혹혈관내개입치료。접수외과수술협폐적외과조19례환자중，삼유DSA결과여외과술중소견문합；이접수혈관내치료적개입조44례환자（47개동맥류）균접수료혈관내개입치료。평균수방시간위10개월，수방중개입조유6례발생병발증。개입조1례환자인미도관삽관미도위이치전새실패，전입외과조성공진행료동맥류협폐술。외과조기술성공솔100．0％，개입조기술성공솔97．7％；수방중개입조병발증발생솔위13．6％，외과조위0．0％。술후10예외과조화19례개입조환자유CTA혹DSA복사자료。본연구수방중몰유동맥류치료후재출혈적발생。결론삼유선전DSA제공료고질량적다방위도상，유리우뇌동맥류파렬출혈환자치료방안적제정。기우다학과합작기출적삼유선전DSA기술용우차류환자적급진수선검사안전유효。
Objective To evaluate the clinical application of three-dimensional rotational angiography (3D-RA)as emergency procedure in the treatment of ruptured intracranial aneurysms .Methods Between Jan 2010 and May 2012, sixty-three patients underwent 3D-RA as emergency procedure and intracranial aneurysms were confirmed in all those patients .Endovascular treatment and surgical clipping were scheduled according to the results of the procedures .The initial 3D-RA results were evaluated and compared with endovascular and surgical findings .Clinical outcome and follow up results were recorded and analyzed . Results A total of 66 cerebral aneurysms were detected by 3D-RA and treated.3D-RA with reconstructed CT images correlated well with the surgical findings in 19 patients(surgical group).Meanwhile,47 aneurysms in 44 patients(endovascular group)were treated by endovascular procedures .Clinical follow up was completed for a mean duration of 10 months.Complications were revealed during the follow up in 6 cases in the endovascular group .One aneurysm coiling procedure failed because of unsuccessful micro-catheterization and the patient was transferred to surgical clipping successfully .The technique success rate was 100.0% in the surgical group and 97.7% in the endovascular group .Conclusions Emergency 3D-RA provides enough evidence to determine the optimal treatment plan for ruptured intracranial aneurysms .A strategy of using 3D-RA for aneurysmal hemorrhage appears to be practical and safe with multi-disciplinary team work in selected cases and qualified clinical centers .