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目的 探讨颅内动脉瘤电解可脱卸弹簧圈(GDC)血管内栓塞术后载瘤动脉缺血的临床治疗及相关影响因素。方法 选择颅内动脉瘤经血管内GDC栓塞治疗病例41例,术后7例出现载瘤动脉闭塞。就其相关因素,治疗方法、临床结果进行分析、探讨。结果 颅内动脉瘤Hunt-Hess分级1～3级41例病例中,经血管内GDC栓塞治疗后,7例出现载瘤动脉主干或其分支闭塞缺血所造成相应的临床神经症状,头疼、头昏、偏瘫、失语、偏盲及出血;经过三高(高血压、高内容量和高血稀释度)、抗痉挛、腰穿等综合治疗后,5例恢复良好,2例遗留偏瘫。结论 颅内动脉瘤栓塞后出现载瘤动脉主干狭窄或闭塞是其易发并发症之一,术中动态观察载瘤动脉血供情况,了解栓塞程度是预防其发生的手段之一,出现狭窄或闭塞时,要及时调整GDC和微导管,并给以抗痉挛、抗凝、扩血管以及三高治疗,当出现恶性颅高压症时手术配合治疗,往往会取得较好的临床效果。
Objective To investigate the clinical treatment and related factors of intracranial artery aneurysm after intra-arterial embolization of intracranial aneurysm electrolytically detachable coil (GDC). Methods 41 cases of intracranial aneurysms were treated by intravascular GDC embolization, and 7 cases had occlusion of the parent artery after operation. The related factors, treatment methods, clinical results were analyzed and discussed. Results In the 41 patients with Hunt-Hess grade 1 ~ 3 of grade 1, the corresponding clinical neurological symptoms, headache, and head caused by occlusion of the main artery of the parent artery or occlusion of its branches after endovascular GDC embolization Fainting, hemiplegia, aphasia, hemianopia and bleeding. After three highs (high blood pressure, high content and high blood dilution), anticonvulsant, lumbar puncture and other comprehensive treatment, 5 patients recovered well and 2 left hemiplegia. Conclusions The main stenosis or occlusion of the host artery after embolization of intracranial aneurysm is one of its complications. The intra-arterial blood supply to the aneurysm is observed dynamically and the degree of embolism is one of the ways to prevent its occurrence. The occurrence of stenosis or Occlusion, we must promptly adjust the GDC and microcatheter, and to anti-spasm, anticoagulation, vasodilators and three high treatment, when the surgical treatment of malignant intracranial hypertension often tend to achieve better clinical results.