CAJ | 학술논문

目的探讨急性出血期颅内动脉瘤血管内栓塞术中局部肝素化的安全性.方法收集2011年4月至2011年9月经血管内治疗的127例急性出血期(＜14 d)颅内动脉瘤患者(共148个动脉瘤)的临床资料,该组患者在血管内栓塞术中均应用局部肝素化(经导引导管高压灌注浓度为3 IU/ml的肝素生理盐水,灌注速度为4 ml/min),回顾性分析术中血栓栓塞和动脉瘤破裂的发生率及预后.结果 127例患者148个动脉瘤中,行介入栓塞135个,其中5例(3.9％)发生术中动脉瘤破裂,均与操作相关,术后4例死亡,1例重残.11例(8.7％)术中出现载瘤动脉远端显影不良,其中2例(1.6％)和载瘤动脉痉挛有关,均预后良好;7例(5.5％)和弹簧圈过度栓塞有关,其中6例恢复良好,1例重度残疾;2例(1.6％)术中形成原发血栓,1例恢复良好,1例重度残疾.术后3.0～3.5年格拉斯哥预后评分(GOS):1分(死亡)7例(5.5％),2分(植物生存)0例(0％),3分(重度残疾)6例(4.7％),4分(轻度残疾)7例(5.5％),5分(恢复良好)107例(84.3％).结论对于急性出血期的颅内动脉瘤,在血管内栓塞术中应用局部肝素化是安全的,与传统系统肝素化相比不增加血栓栓塞性并发症的风险,并可能避免系统肝素化所伴随的出血风险.
목적 탐토급성출혈기로내동맥류혈관내전새술중국부간소화적안전성.방법 수집2011년4월지2011년9월경혈관내치료적127례급성출혈기(＜14 d)로내동맥류환자(공148개동맥류)적림상자료,해조환자재혈관내전새술중균응용국부간소화(경도인도관고압관주농도위3 IU/ml적간소생리염수,관주속도위4 ml/min),회고성분석술중혈전전새화동맥류파렬적발생솔급예후.결과 127례환자148개동맥류중,행개입전새135개,기중5례(3.9％)발생술중동맥류파렬,균여조작상관,술후4례사망,1례중잔.11례(8.7％)술중출현재류동맥원단현영불량,기중2례(1.6％)화재류동맥경련유관,균예후량호;7례(5.5％)화탄황권과도전새유관,기중6례회복량호,1례중도잔질;2례(1.6％)술중형성원발혈전,1례회복량호,1례중도잔질.술후3.0～3.5년격랍사가예후평분(GOS):1분(사망)7례(5.5％),2분(식물생존)0례(0％),3분(중도잔질)6례(4.7％),4분(경도잔질)7례(5.5％),5분(회복량호)107례(84.3％).결론 대우급성출혈기적로내동맥류,재혈관내전새술중응용국부간소화시안전적,여전통계통간소화상비불증가혈전전새성병발증적풍험,병가능피면계통간소화소반수적출혈풍험.
Objective To evaluate the efficacy of ization in endovascular embolization of the ruptured intracranial aneurysms at acute stage.Methods Between April 2011 and September 2011,127 patients with ruptured intracranial aneurysms treated with endovascular embolization at acute stage (＜ 14 days) were retrospectively reviewed to evaluate the efficacy of ization (3 IU/ml heparin saline was dropped into the guiding catheter at 3 ml/min.).Results Total 148 aneurysms were observed in 127 patients and 135 aneurysms were treated with endovascular coil embolization under ization at acute stage,aneurysm perforation related to manipulation occurred in 5 patients (3.9％) which caused 4 deaths and 1 disability.The distal part of the parent artery was not filled well in 11 cases (8.7％),vasospasm in 2 cases without any neurological sequelae,over embolization in 7 cases resulted in 1 severe disability.Thromboembolic complication occurred in 2 cases causing 1 neurological deficit.Clinical outcomes at3.5 years were:GOS 5 in 107 cases (84.3％),4 in 7 cases (5.5％),3 in 6 cases (4.7％),2 in 0 cases (0％) and 1 in 7 cases (5.5％).Conclusions Local heparinizqtion may not increase the incidence of thromboernbolic or hemorrhagic complications compared to systemic heparin.ization could be effective for coil embolization of ruptured aneurysm at acute stage.