[1]潘奇,刘建民,许奕,等.颅内破裂动脉瘤栓塞术后早期破裂再出血危险因素分析[J].介入放射学杂志,2010,(02):95.
 PAN Qi,LIU Jianmin,XU Yi,et al.Risk factors of early rebleeding after endovascular embolization of ruptured intracranial aneurysms[J].journal interventional radiology,2010,(02):95.
点击复制

颅内破裂动脉瘤栓塞术后早期破裂再出血危险因素分析()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2010年02期
页码:
95
栏目:
神经介入
出版日期:
2010-02-15

文章信息/Info

Title:
Risk factors of early rebleeding after endovascular embolization of ruptured intracranial aneurysms
作者:
潘奇刘建民许奕
730030兰州解放军第一医院骨神经外科(潘奇);第二军医大学长海医院神经外科(刘建民、许奕、洪波、赵文元、黄清海、李强、赵瑞、杨志刚)
Author(s):
PAN Qi LIU Jian-minXU Yi HONG Bo ZHAO Wen-yuanHUANG Qing-haiLI QiangZHAO Rui YANG Zhi-gang
the First Hospital of People’s Liberation Army ,Lanzhou730030,China
关键词:
颅内破裂动脉瘤血管内介入治疗栓塞破裂再出血早期危险因素再治疗
分类号:
R743.4
文献标志码:
A
摘要:
目的探讨颅内破裂动脉瘤栓塞术后早期破裂再出血的临床特点及危险因素,以减少动脉瘤栓塞术后早期再出血的发生率,为临床治疗方法的选择提供依据。方法回顾性分析我科2002年7月至2007年10月经全脑血管造影确诊的颅内破裂动脉瘤并行血管内介入栓塞治疗的病例,分析栓塞术后早期再出血病例(病例组)的临床及影像学特征,从同期治疗的未再出血的患者中随机抽取123例病例作为对照组,对两者的可疑危险因素进行单变量与多变量的统计学分析。结果881例行介入栓塞治疗的颅内破裂动脉瘤中有17例(1.93%)发生早期破裂再出血,其中12例(占70.6%)死亡。颅内破裂动脉瘤栓塞术后早期破裂再出血的独立危险因素为动脉瘤的真假性、术前动脉瘤的破裂次数、术中造影有明显的脑血管痉挛及动脉瘤的栓塞程度4项。并得到预测栓塞术后早期再出血概率的方程。结论本研究显示栓塞术后早期破裂再出血的发生率低,但预后差,病死率高。术前针对危险因素进行预防、术中尽可能致密栓塞动脉瘤、术后早期及时复查脑血管造影有利于减少颅内破裂动脉瘤栓塞术后早期再出血率,积极再治疗可以改善早期再出血患者的预后。

参考文献/References:

[1]Molyneux A,Kerr R,Stratton I,et al.International Subarachnoid Aneurysm Trial(ISAT)of neurosurgical clipping versus endovascular coiling in2143patients with ruptured intracranial aneurysms :a randomized trial[J].Lancet,2002,360:1267-1274.
[2]Molyneux AJ ,Kerr RS,Yu LM,et al.International subarachnoid aneurysm trial[ISAT]collaborative group:international subarachnoid aneurysm trial[ISAT]of neurosurgical clipping versus endovascular coiling in2143patient s with ruptured intracranial aneurysms :a randomized comparison of effects on surviaval,dependency,seizures,rebleeding,subgroups,and aneurysms occlusion[J].Lancet,2005,366:809-817.
[3]张桂运,陈左权,顾斌贤,等.颅内破裂动脉瘤栓塞术后早期再次破裂原因分析[J].中华神经外科杂志,2007,23:819-822.
[4]Sluzewski M,van Rooij WJ .Early rebleeding after coiling of ruptured cerebral aneurysms :incidence,morbidity,and risk factors[J].AJNR,2005,26:1739-1743.
[5]Sluzewski M,Van Rooij WJ ,Beute GN,et al.Late rebleeding of ruptured intracranial aneurysms treated with detachable coil[J].AJNR,2005,26:2542-2549.
[6]The CARAT investigators.Rate of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment [J].Stroke,2006,37:1437-1442.
[7]Yadav JS.Management practices in carotid stenting[J].Cere-brovasc Dis,2001,11(Suppl 2):18-22.
[8]Aikawa H,Kazekawa K,Nagata S,et al.Rebleeding after9 endovascular embolization of ruptured cerebral aneurysms [J].Neurol Med Chir(Tokyo),2007,47:439-447.
[9]赵振伟,邓剑平,高国栋.颅内破裂动脉瘤栓塞后再出血分析[J].中国微侵袭神经外科杂志,2006,11:497-499.
[10]Nomura M,Kida S,Uchiyama N,et al.Ruptured irregularly shaped aneurysms :pseudoaneurysm formation in a thrombus located at the rupture site[J].J Neurosurg,2000,93:998-1002.
[11]Mori K,Kasuga C,Nakao Y,et al.Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm(“ghost aneurysm”):radiological findings and therapeutic implications in two cases[J].Neurosurg Rev,2004,27:289-293.
[12]林世和,赵节绪,江新梅,等.大脑动脉环前部破裂动脉瘤的病理研究[J].中国脑血管病杂志,2004,4:156-159.
[13]Mueller-Kronast N,Jahromi BS.Endovascular treatment of ruptured aneurysms and vasospasm[J].Curr Treat Options Neurol,2007,9:146-157.
[14]Tanoue S,Kiyosue H,Matsumoto S,et al.Ruptured“blisterlike”aneurysms with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization:case report[J].J Neurosurg,2004,101:159-162.
[15]Friedman JA,Nichols DA,Meyer FB,et al.Guglielmi detachable coil treatment of ruptured saccular cerebral aneurysms :retrospective review of a10-year single-center experience[J].Am J Neuroradiol,2003,24:526-533.
[16]Murayama Y,Nien YL,Duckwiler G,et al.Guglielmi detachable coil embolization of cerebral aneurysms :11years’experience[J].J Neurosurg,2003,98:959-966.
[17]Hayakawa M,Murayama Y,Duckwiler GR,et al.Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system[J].J Neurosurg,2000,93:561-568.
[18]Piotin M,Iijima A,Wada H,et al.Increasing the packing of small aneurysms with complex-shaped coils:an in vitro study[J].AJNR,2003,24:1446-1448.
[19]Tamatani S,Ito Y,Abe H,et al.Evaluation of the stability of aneurysms after embolization using detachable coils:correlation between stability of aneurysms and embolized volume of aneurysms [J].AJNR,2002,23:762-767.
[20]Raymond J,Roy D.Safety and efficacy of endovascular treatment of acutely ruptured aneurysms [J].Neurosurgery,1997,41:1235-1245.
[21]陈立一,龙霄翱.颅内动脉瘤介入栓塞治疗后早期再破裂原因探讨及预防[J].中国综合临床,2007,23:622-623.
[22]Hoh BL,Nogueira RG,Ledezma CJ ,et al.Safety of heparini-zation for cerebral aneurysm coiling soon after external ventriculostomy drain placement [J].Neurosurgery,2005,57:845-849.
[23]Sinson G,Bagley LJ ,Flamm ES,et al.Fatal rebleeding following coil embolization of cerebral aneurysms :the role of long-term systemic anticoagulation[J].Neuroradiology,2001,43:398-404.
[24]Bernardini GL,Mayer SA,Kossoff SB,et al.Anticoagulation and induced hypertension after enderovascular treatment for ruptured intracranial aneurysms [J].Crit Care Med,2001,29:641-644.
[25]潘奇,刘建民,许奕,等.颈内动脉前壁动脉瘤支架结合弹簧圈栓塞术后再出血病例报道[J].介入放射学杂志,2008,17:560-563.[26]潘奇,刘建民,许奕,等.颅内破裂动脉瘤血管内介入治疗后再出血危险因素研究进展[J].介入放射学杂志,2009,18:782-785.

相似文献/References:

[1]张强,李慎茂,吉训明,等.血管内介入治疗颅内静脉窦血栓形成[J].介入放射学杂志,2007,(05):303.
 ZHANG Qiang LI Shen-mao JI Xun-ming MIAO Zhong-rong ZHU Feng-shui ZHI Xing-long LING Feng.Endovascular treatment for intracranial venous sinus thrombosis[J].journal interventional radiology,2007,(02):303.
[2]万军,张晓龙,鲁刚,等.颅内破裂囊状动脉瘤的血管内介入治疗[J].介入放射学杂志,2010,(11):847.
 WAN Jun,ZHANG Xiao-long,LU Gang,et al.Endovascular treatment of ruptured saccular intracranial aneurysms[J].journal interventional radiology,2010,(02):847.
[3]张纪庆,王志刚.水凝胶水解式微弹簧圈在颅内动脉瘤治疗中的应用[J].介入放射学杂志,2007,(10):710.
 ZHANG Ji-qing,WANG Zhi-gang.Hydrocoil for the treatment of intracranial aneurysms[J].journal interventional radiology,2007,(02):710.
[4]郄福忠 肖玉强 马光涛.Hunt-HensV级颅内动脉瘤的早期介入栓塞治疗31例[J].介入放射学杂志,2011,(11):841.
 QIE Fu-zhong,XIAO Yu-qiang,MA Guang-tao..Endovascular Embolization Treatment of Hunt-HensV Ruptured Intracranial Aneurysms in Early Stage.[J].journal interventional radiology,2011,(02):841.
[5]潘奇,刘建民,许奕,等.颅内破裂动脉瘤血管内介入治疗后再出血危险因素研究进展[J].介入放射学杂志,2009,(10):782.
 PAN Qi,LIU Jianmin,XU Yi,et al.Recent progress in the research of rebleeding risk factors of ruptured intracranial aneurysms after endovascular intervention[J].journal interventional radiology,2009,(02):782.

备注/Memo

备注/Memo:
收稿日期:2009-09-29
更新日期/Last Update: 2010-02-15