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目的探讨颅内动脉瘤栓塞术后再通、出血等问题及数字减影血管造影(DSA)随访的必要性。方法选择用GDC或EDC、MDS、Matrix微弹簧圈行血管内栓塞的颅内动脉瘤患者102例,共114个动脉瘤,112个动脉瘤行血管内栓塞,2例多发性动脉瘤患者各有1个小动脉瘤未行栓塞。随访时间为术后1个月至6．5年,平均10．5个月。随访方法为DSA,将随访时的DSA资料与栓塞术后即刻DSA资料进行对比分析。结果初始治疗的动脉瘤闭塞率为100%的58个(51．79%),≥95%的37个(33．04%),＜95%的17个(15．17%)。栓塞治疗后弹簧圈稳定的动脉瘤87个(77．68%),残腔体积缩小6个(5．36%),再通19个(16．96%)。采用GDC或EDC栓塞的90个动脉瘤中,14个再通(15．56%)。闭塞100%、≥95%和＜95%的动脉瘤,再通率分别为4．08%、26．67%和36．36%,三者之间差异有极显著性(P＜0．01)。对术后再通的动脉瘤,9个及时补充GDC栓塞后均未发生再出血,而继续观察的5个动脉瘤中,有1个不全闭塞者发生迟发性再出血。随访结果,经MDS栓塞治疗的18个动脉瘤中,5个再通。采用Ma- trix微弹簧圈或Neuroform支架+Matrix微弹簧圈治疗的4个动脉瘤,无论是近乎完全闭塞还是不完全闭塞,DSA均显示动脉瘤完全闭塞。结论颅内动脉瘤栓塞术后再通与初始治疗的闭塞程度、栓塞材料等因素有关。对闭塞不完全的动脉瘤,应通过DSA进行随访,若明显再通,需及时补充栓塞。
Objective To investigate intracranial aneurysm embolization recanalization, bleeding problems and the need for digital subtraction angiography (DSA) follow-up. The method of selecting GDC or EDC, MDS, 102 patients with intracranial tumors embodiment intravascular embolization Matrix microcoil row, a total of 114 aneurysms, endovascular aneurysm 112 rows, two cases have multiple aneurysms A small aneurysm embolism. Follow-up time was 1 month to 6.5 years after operation, with an average of 10.5 months. The follow-up method was DSA, and the DSA data at follow-up were compared with the DSA data immediately after embolization. Results Initial aneurysm occlusion rates were 58 (51.79%) for 100%, 37 (33.04%) for ≥95%, and 17 (15.17%) for <95%. After stable coil embolization of the aneurysm 87 (77.68%), reduced the volume of the residual cavity 6 (5.36%), and then pass 19 (16.96%). Out of 90 aneurysms embolized with GDC or EDC, 14 recanalized (15.56%). The occlusion rates of aneurysms of 100%, ≥95% and <95% were 4.08%, 26.67% and 36.36%, respectively, with significant differences between the three groups (P <0.01 ). There was no rebleeding of 9 recurrent aneurysms after GDC embolization in 9 patients, and one of the 5 aneurysms that were observed continued to have delayed recurrent bleeding. Follow-up results, MDE embolization of 18 aneurysms, 5 recanalization. Microcoil using Matrix + Matrix ring or stent therapy Neuroform micro aneurysms spring 4, both near complete or incomplete occlusion occlusion, DSA showed complete occlusion of the aneurysm. Conclusions The intracranial aneurysm embolization after recanalization with the initial treatment of occlusion, embolic material and other factors. On the incomplete occlusion of aneurysms, DSA should be followed up, if significant recanalization, the need for timely embolization.