CAJ | 학술논문

目的：分析球囊联合支架辅助弹簧圈栓塞术治疗颅内分叉部宽颈动脉瘤的优势。方法回顾性分析2014年1月至4月昆明医科大学第一附属医院采用球囊联合支架辅助弹簧圈栓塞术治疗20例共25枚颅内分叉部宽颈动脉瘤患者的临床资料。20例患者中曾患蛛网膜下腔出血12例，无出血史8例；25枚颅内分叉部宽颈动脉瘤中位于基部动脉未端分叉部14枚，大脑中动脉分叉部8枚，颈内动脉末端分叉部3枚。根据Raymond分级评价介入治疗术后即刻和3个月后三维DSA检查结果，根据改良Rankin 量表（mRS）评分评价术后3个月临床疗效。结果球囊联合支架辅助弹簧圈栓塞术后即刻三维DSA检查显示25枚颅内分叉部宽颈动脉瘤中RaymondⅠ级21枚，Ⅱ级2枚，Ⅲ级2枚；术后3个月DSA随访显示RaymondⅠ级20枚，Ⅱ级3枚，Ⅲ级2枚。术后3个月mRS评分显示17例患者0分，1例患者1分，均预后良好；2例患者4～6分，预后不良。结论球囊联合支架辅助弹簧圈栓塞术在颅内分叉部宽颈动脉瘤介入治疗术中具有明显优势。
목적：분석구낭연합지가보조탄황권전새술치료로내분차부관경동맥류적우세。방법회고성분석2014년1월지4월곤명의과대학제일부속의원채용구낭연합지가보조탄황권전새술치료20례공25매로내분차부관경동맥류환자적림상자료。20례환자중증환주망막하강출혈12례，무출혈사8례；25매로내분차부관경동맥류중위우기부동맥미단분차부14매，대뇌중동맥분차부8매，경내동맥말단분차부3매。근거Raymond분급평개개입치료술후즉각화3개월후삼유DSA검사결과，근거개량Rankin 량표（mRS）평분평개술후3개월림상료효。결과구낭연합지가보조탄황권전새술후즉각삼유DSA검사현시25매로내분차부관경동맥류중RaymondⅠ급21매，Ⅱ급2매，Ⅲ급2매；술후3개월DSA수방현시RaymondⅠ급20매，Ⅱ급3매，Ⅲ급2매。술후3개월mRS평분현시17례환자0분，1례환자1분，균예후량호；2례환자4～6분，예후불량。결론구낭연합지가보조탄황권전새술재로내분차부관경동맥류개입치료술중구유명현우세。
Objective To discuss the advantages of balloon combined with stent-assisted steel-coil embolization in treating intracranial wide-necked aneurysms located at artery bifurcation sites. Methods The clinical data of 20 patients with intracranial wide-necked aneurysms located at artery bifurcation sites (25 aneurysms in total), who were admitted to the First Affiliated Hospital of Kunming Medical University during the period from January 2014 to May 2014 to receive balloon combined with stent-assisted steel-coil embolization treatment, were retrospectively analyzed. Among the 20 patients, 16 had a history of subarachnoid hemorrhage and 4 had no history of subarachnoid hemorrhage. A total of 25 intracranial aneurysms located at artery bifurcation were detected; the locations included basilar terminal bifurcation (n=14), middle cerebral artery (MCA) bifurcation (n=8) and internal carotid artery (ICA) bifurcation (n=3). Three dimensional DSA was performed immediately and three months after the treatment , and the manifestations were evaluated according to Raymond classification. The clinical efficacy at three months after the treatment was assessed with the modified Rankin scale (mRS). Results Three dimensional DSA performed immediately after the balloon combined with stent-assisted steel-coil embolization treatment showed that among the 25 intracranial wide-necked aneurysms located at artery bifurcation 21 belonged to Raymond gradeⅠ, 2 belonged to Raymond grade Ⅱand 2 belonged to Raymond grade Ⅲ. Follow-up DSA performed three months after the treatment revealed that 20 aneurysms were Raymond grade Ⅰ, 3 aneurysms were Raymond gradeⅡand 2 aneurysms were Raymond grade Ⅲ. Three months after the treatment the mRS score was 0 point in 17 patients and one point in one patient, and the prognosis of these patients was good; the mRS score was 4-6 points in 2 patients, and the prognosis of the two patients was poor. Conclusion For the treatment of intracranial wide-necked aneurysms located at artery bifurcation sites, balloon combined with stent-assisted steel-coil embolization has obvious advantages.