Clinical Study Of Endovascular Interventional Treatment For Ophthalmic Segment Aneurysms Of Internal Carotid Artery

Research Objective:In this thesis,by means of making a retrospective analysis of the following issues: first,clinical data of patients with ophthalmic segment aneurysms of internal carotid artery,clinical characteristics and treatment results;then,safety and validity of endovascular interventional treatment;complications,recurrence rate and radiographic recurrence rate of peri-operative aneurysms and related factors that influence post-recovery,the author intends to conclude clinical experience in order to provide references for further clinical treatment.Research Methodology: Based on clinical data of 120 patients with intracranial aneurysms endovascular diseases in Yijishan Hospital of Wannan Medical College Neurosurgery from January 1st,2013 to December 30 th,2015,the analysis covers following aspects: sex ratio,morbidity age,aneurysm shape and size,preoperative classification of Hunt-Hess,aneurysm embolization situations and operation methods,analysis of preoperative complications,conclusions of MRS assessment and clinical and radiologic follow-ups,in process of which statistical methods say SPSS19.0 software,2 test,Wileoxon rank sum test and Fisher exact test are adopted.Results: First,in 87 cases of ophthalmic segment aneurysms of internal carotid artery,there are 28 male cases(32.2%),and 59 female ones(67.8%),where male to female ratio is 1: 2.107 with an average age of 52.77 years.In 87 cases of patients,94 ophthalmic segment aneurysms of internal carotid artery were found,among which there are 66 cases with micro-aneurysm,12 cases with medium-sized aneurysm,16 cases with large aneurysm and 1 case with giant aneurysm as to sizes of aneurysm;as to shapes of aneurysm,there were 32 cases with saccular aneurysm,12 with bloodblister-like aneurysm,10 with cone aneurysm and 40 with irregularly aneurysm;as to breadth of aneurysm,82 wide-necked aneurysms and 12 narrow-necked aneurysms.Second,The Hunt-Hess grades of patients covered 71 cases of Grade 0-III,and 16 cases of Grade IV-V.Among 94 healing cases of aneurysm,embolization was treated either by means of simple coil(32 cases),or stent-assisted coil(62 cases).Angiography immediately after surgery showed that there were 79 pyknotic embolization cases(84.0%),9 aneurysmal neck residual cases(9.6%),and 6 partial embolization cases(6.4%).After surgery,as to the extent of instant embolization,there were no significant difference(P>0.05)in wide-necked and narrow-necked aneurysm.As to ratio of aneurysmal neck residue,simple coil group was higher than stent-assisted coil one.There was no obvious statistical difference(P>0.05)on pyknotic embolization and partial embolization.In 87 cases of ophthalmic segment aneurysms of internal carotid artery(94 cases of aneurysm),there were 7 cases(8.0% occurrence rate)with peri-operative complications including 1 death(1.2% death rate),3 disabilities(3.5% disability rate).In mid of the operation,there were 5 cases of thrombosis surgery,4 cases of severe cerebral vasospasm,and 1 cerebral infarction case(3.3%).Therefore,it can be concluded that risks of blood clots are lower in use of simple coil group than stent-assisted coil one(P<0.05).Third,when discharging from hospital,there were 75 cases(86.2%)favorable prognosis,12 cases(13.8%)poor prognosis,3 cases in disability(3.5% disability rate),1 death case(1.2% deaths rate).Before surgery,there were two groups of patients whose Hunt-Hess grading ranked 0-III and IV-V.When discharging from the hospital,it was found that the group of patients whose Hunt-Hess grading rank 0-III had lower rate of disability and death,and more favorable prognosis rate(P<0.01)in comparison with MRS scores.As to patients with ophthalmic segment aneurysms of internal carotid artery,recurrence rate in partial embolization group was the highest;recanalization rate in aneurysmal neck residual group ranked the second;and pyknotic embolization was the lowest(P<0.01).Follow-up studies showed that broad-necked OSAs-ICA patients had higher recurrence rate than narrow-necked OSAs-ICA patients(P<0.05).Recurrence rate of arterial aneurysm in groups of patients who were treated by means of stent-assisted coil was lower than simple coil.Conclusions: First,endovascular embolization therapy for the treatment of ophthalmic segment aneurysms of internal carotid artery is safe and effective.Second,Hunt-Hess classification of patients in level of 0-III enjoys much more favorable survival prognosis than patients with IV-V grades;Third,stent can help to improve therapeutic efficiencies of broad-necked OSAsICA patients in spite of high surgery risks.Dealing with intra-operative complications timely can efficiently improve treatment quality and decrease poor prognosis.