破裂和未破裂颅内动脉瘤栓塞治疗实践标准

Standard of practice: embolization of ruptured and unruptured intracranial aneurysms

摘要:

1 引言 弹簧圈栓塞最初被设计并经美国食品药品监督管理局批准用于治疗显微外科手术夹闭风险高的脑动脉瘤,但目前该方法越来越被认为是颅内动脉瘤的一线治疗方法.动脉瘤血管内治疗技术已有长足进步,新器材的研发使得以前因血管解剖结构复杂而无法填塞的动脉瘤也得以治疗,从而扩大了血管内治疗的适应证.而且,血管内弹簧圈栓塞已成为当前动脉瘤血管内治疗的主流方法;医学文献证明,在特定患者人群中,弹簧圈栓塞的转归优于外科手术夹闭[1-3].最近的一份美国心脏协会(American Heart Association,AHA)科学声明指出,对于适合治疗的脑动脉瘤,不论是血管内栓塞还是显微外科手术夹闭,均为破裂动脉瘤Ⅰ级推荐治疗方法和未破裂动脉瘤的Ⅱa级推荐治疗方法[4].在这两组患者中,治疗利大于弊.一个在血管显微神经外科、神经重症监护和介入神经外科方面有着丰富经验的多学科团队最有利于对颅内动脉瘤的处理实施最佳的技术.神经血管联合写作组此前已发表过一份联合声明,提出了有关脑血管介入治疗的培训和认证的推荐意见[5].

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作者: Athos Patsalides [1] Ketan R Bulsara [2] Daniel P Hsu [3] Todd Abruzzo [4] Sandra Narayanan [5] Mahesh V Jayaraman [6] Gary Duckwiler [7] Richard Paul Klucznik [8] Michael Kelly [9]
作者单位: Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA [1] Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA [2] Department of Interventional Neuroradiology, University Hospitals, Case Medical Center,Cleveland, Ohio, USA [3] Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA [4] Departments of Neurosurgery & Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA [5] Departments of Diagnostic Imaging and Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA [6] Department of Radiological Sciences, UCLA Medical Center, Los Angeles,California, USA [7] Department of Neuroradiology,Methodist Hospital, Houston, Texas, USA [8] Department of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada [9]
期刊: 《国际脑血管病杂志》2013年21卷6期 418-424页 ISTICPKU
栏目名称: 标准与指南
DOI: 10.3760/cma.j.issn.1673-4165.2013.06.002
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