Clinical Study Of Endovascular Interventional Treatment For Intracranial Aneurysm

Section one The clinical data about the patients of intracranial aneurysmObjective We investigated the patients with intracranial aneurysm about the clinical representation,the imaging findings and the methods of embolism,to summarize the proportion and embolism stuff of intracranial aneurysm in various location and different size,and analyze its etiological factors and natural history.To direct the clinical treatment,we established data bank about the endovascular interventional patients of intracranial aneurysm,which had its feature.Methods The data of 286 patients with intracranial aneurysm were arranged from January 2002 to January 2006.All patients with intracranial aneurysm were confirmed by imageology and treated in our department.The clinical data included sex ratio,age of patients,common condition of patients,and chief or accompaniment symptom of patients,intracranial hemorrhage,focal symptom,and ischemic appearance.We used the modified Hunt and Hess grading scale to estimate the condition of hospital patients before operated.The imaging check reported the sites of aneurysm;the aneurysms' length and width and aneurysms' length/width;the location and quantity of intracranial hemorrhage;the association of aneurysms' sites and intracranial hemorrhage.Through endovascular interventional treatment to observed its various methods and different embolism stuff.All data were coped with SPSS10.0 statistic software packageResults In clinical data of 286 patients with intracranial aneurysm,male 125 cases, female 161 cases,the average age of male is 46.3 years old and female is 49.7,the average age of male and female is 48.2 years old.There are 317 aneurysms in 286 patients,and 26 patients with more than two aneurysms,male 11 cases and female 15 cases.In 317 aneurysms,ICA-PcoA and other ICA are 145 cases(45.7%),AcoA are 82 cases(25.9%),MCAare 29 cases(9.2%),ACAare 22 cases(6.9%), BA-VA are 39 cases(12.3%);small aneurysms are 109 cases(34.4%),midst aneurysms are 138 cases(43.5%),large aneurysms are 55 cases(17.4%),great aneurysms are 15 cases(4.7%).Embolism stuff includes various coils,intracranial stent,detachable balloon,and Onyx mastic.Conclusion This group of clinical patients with aneurysms have natural random. The main characteristics are close to the results of a large series of cases which were reported by article.The statistic results are confident.We investigate this group of patients and analyze its invasion,clinical symptoms,imaging characteristics, endovascular interventional treatment,and so on.It can apply for treating patients with intracranial aneurysms.Section two Clinical evaluation of endovascular interventional treatment for intracranial aneurysmObjective To study and summarize various methods of endovascular interventional treatment and technique highlight of embolism for intracranial aneurysm.We estimated various methods of treatment by the representative clinical data and the results of follow-up imaging findings,and discussed the occurrence,precaution and disposal of complication in process of interventional treatment.Then raised it in systemic and theoretic,it will be applied theory for supporting individuate interventional treatment of patients with intracranial aneurysm in clinic.Methods We summarized and analyzed three kinds of contents by the clinical data of this group of patients.First,we discussed the interventional treatment methods of intracranial aneurysm,including Guglielmi Detachable Coil,technique of remodeling,helping of stent,blocking up artery for aneurysm by balloon,Onyx,and cover stent.Second,we analyzed results of clinical follow-up and follow-up of imaging findings.At last,we discussed the occurrence,precaution and disposal of complication in process of interventional treatment.All data were coped with SPSS10.0 statistic software package.Results In this group of patients,191 cases were embolized only by coils,6 cases were embolized by stent and coils,11 cases were embolized by technique of remodeling,2 cases were embolized by Onyx,2 cases were embolized by cover stent. We completely embolized 180 cases(77.9%),imperfectly embolized 38 cases (16.5%),and inadequately embolized 13 cases(5.6%)2 aneurysms(0.9%) ruptured during the embolization.6 patients had cerebral infarction or thrombosis.7 cases occurred cerebral vasospasm.No coil escaped during operation.The Modified Rankin Scale of patients with aneurysm at leaving hospital and operation after 12 months was used to evaluate quality of life after operation.There are 91%whose scale is 0 to 2 at leaving hospital,and 94%at operation after 12 months.After leaving hospital 12 months,135 patients(87%)can work and live normally,15 cases (10%)have feeble and middle nerve functional disturbance,and 5 cases(3%)have severe nerve functional disturbance or died.In 131 patients who had follow-up by imaging,one case hemorrhaged again(0.76%),recanalization of aneurysm occurred in 11 cases(6.9%),4 patients had hydrocephalus.Conclusion Endovascular interventional treatment for patients with intracranial aneurysms is an effective method.According to clinical symptom,amount and site of hemorrhage,imaging feature of aneurysm,and so on,we can adopt project with individuate interventional treatment,which include much factor,such as selecting work angle,selecting and reconstructing microcatheter,whether or not using balloon and stent,the size of coils,the amount of coils,and the type of coils.Operational complications are closely associated with selecting method of interventional treatment and manipulation detail of operator.Clinical follow-up have important significance for treatment of patients with intracranial aneurysm.Recurrence of aneurysm is major substance in follow-up.