Perioperative Clinical Study Of Combining TCM And Western Medicine To Treat Intracranial Aneurysms

ObjectiveTo learn the safety and efficacy of operation treatment of intracranial aneurysms, especially the selection of interventional treatment methods and intraoperative complications of intracranial very Small aneurysms, wide-necked aneurysms, dissection aneurysms, and fusiform aneurysms. To observe the changes on the levels of the cerebrospinal fluid endothelin-1(ET-1), nitric oxide (NO) after subarachnoid hemorrhage (SAH), and to explore the mechanism of NaomaiJiejing Tang prevent the vasospasm after SAH.Methods1By selected cases by age, sex, admission CT and HUNTHESS grade and Aneurysm diameter, aneurysm neck width, aneurysm site, the number of aneurysms, the selection of interventional treatment methods and intraoperative complications of intracranial very Small aneurysms, wide-necked aneurysms, dissection aneurysms, and fusiform aneurysms, and discharge GOS score, follow-up statistics on such cases and to describe the frequency distribution.2Systematic stratificate on the selected patients, for all of the above prognostic factors in multiple regression statistical analysis whether the impact of various factors on the prognosis, and further analysis of the weights of various factors and the relationship between various factors.3To learn the differences in the incidence of intraoperative complications by comparative analysis of interventional treatment methods for complex intracranial aneurysms, to evaluate safety and efficacy of pure coil embolization, balloon-assisted coil embolization, stent-assisted coil embolization in the treatment of complex intracranial aneurysms.4A prospective randomized controlled trial designed,60patients were divided into experimental group and control group, the experimental group were given Western therapy and Naomai.liejing Tang orally, the control group was given western medicine, detected cerebrospinal fluid levels of ET-1and NO on3and7days after the onset with the enzyme-labeled immunosorbent assay (ELISA), Doppler detected the incidence of cerebral vasospasm on7days after SAH.Results1General InformationA total of409cases of patients,161cases were male (39.3%) and248cases were females (60.7%), mean age54.47±13.6years old.2State before hospitalfirst symptom in259cases alone were headache (63.4%),81cases of disturbance of consciousness (19.7%), hemiplegia in18cases (4.4%), dizziness onset in18cases (4.4%), ocular symptoms in8cases (2.8%), epilepsy in2cases (0.5%), other18cases (4.4%). CT grade0in103cases (25.18%), grade1in6cases (1.47%),2Grade in181cases (44.15%),3grade in79cases (19.32%),4grade in40cases (9.78%). HUNT-HESS grade0in103cases (25.18%), grade1in25cases (6.11%), grade2in158(38.63%), grade3in71cases (17.36%), grade4in46cases (11.25%).3Intracranial aneurysm siteanterior communicating artery aneurysm in98patients (23.96%), left posterior communicating artery aneurysm55cases (13.45%), right posterior communicating artery aneurysm in46cases (11.25%), left anterior cerebral artery7cases (1.71%), right anterior cerebral artery aneurysms in8cases (1.96%), the left middle cerebral artery aneurysm in23cases (7.33%), right middle cerebral artery aneurysm in32patients (7.82%), the left brain artery aneurysm in4case (0.98%), Right middle cerebral artery aneurysm in3cases (0.73%), basilar artery in26cases (6.36%), left vertebral artery aneurysm in18patients (4.4%), right vertebral artery aneurysm in12cases (2.93%), left internal carotid artery aneurysm in32cases (7.82%), right internal carotid artery aneurysm of38cases (9.29%). Hunt-hess grade and lung infection had a significant effect on the prognosis, P<0.05; Hunt-hess grade had a significant effect on the occurrence of cerebral vasospasm, P<0.05.6The differences in the incidence of interventional treatment methods and intraoperative complications for complex intracranial aneurysms4The difference of methods and complication of complex intracranial aneurysms with interventional treatment46cases of intracranial very small aneurysms,9cases unruptured,38cases ruptured, balloon-assisted embolization in16cases, pure coil embolization in16casesand stent-assisted embolization in11cases, onyx embolization in2case and double catheter technique embolization in1case, failed embolization in1case. Among stent-assisted embolization case, solitaire stent-assisted embolization in six cases, enterprise stent-assisted embolization in four cases, neuroform stent-assisted embolization in1cases. Five cases have intraoperative complications, including1cases due to aneurysm rupture leading to death,1cases due to coil escape to small branch of the brain middle cerebral artery caused aphasia。The remaining are fully restored in which a small amount of intraoperative bleeding in1patient, one coil escape to the brain artery bifurcation in1patient, and a small amount of coil prolapse to the parent artery in1patient.197cases of wide-necked aneurysms, stent-assisted embolization in48cases, failed embolization in1case. Among stent-assisted embolization case, neuroform stent-assisted embolization in9cases, solitaire stent-assisted embolization in24cases, enterprise stent-assisted embolization in15cases. Semi-release technology was adopted in33cases among solitaire and enterprise stent-assisted embolization.8cases have intraoperative complications, including aneurysm rupture in3cases, a small amount of coil prolapse to the parent artery in3cases, Arterial thrombosis in1case. Balloon-assisted embolization in59cases, failed embolization in1case. Intraoperative complicationsincluding aneurysm rupture in1cases, a small amount of coil prolapse to the parent artery in6cases, coil escape to the distal of artery in1case, Arterial thrombosis in1case. Pure coil embolization in90cases, failed embolization in1case, then Surgical clipping. Intraoperative complicationsincluding aneurysm rupture in7cases, a small amount of coil prolapse to the parent artery in9cases, Arterial thrombosis in2case. Double catheter technique embolization in1cases of wide-necked aneurvsm. 25cases of dissection aneurysms, middle cerebral artery in1case Posterior circulation in3cases. Stent-assisted coil embol ization in16cases, simple coil embol ization in3cases, stent placement alone in3cases, parent occlusion in3case. Intraoperative complications including aneurysm rupture in1case leading to death, a small amount of coil prolapse to the parent artery in1cases. Postoperative complications including rebleeding in1case leading to death. Complete embolization was17cases, subtotal embol ization in3cases and partial embolization in5cases.During follow-up aneurysm of two cases in incomplete embolization group enlarge, not rebleed, ang embolism again.5cases of fusiform aneurysms, basilar artery in1case, vertebral artery in1case, middle cerebral artery in1case, internal carotid artery in1case. Stent-assisted coil embolization in3cases, ballon combined stent-assisted coil embolization in1case. In addition to part of the coil prolapse to the parent artery in1case, had no effect on blood flow, no complications in others."Y" stent was placed in the treatment of wide-necked aneurysms in3cases, basilar artery aneurysm in2cases, middle cerebral artery aneurysm in1case2cases with double solitaire stent-assisted embolization,1case with doublel enterprise stent-assisted embolization,, no intraoperative complications happened, postoperative complication in1cases due to the use of aspirin, clopidogrel resulted in cerebellar hemorrhage, the patient died.Simple coil embolization, balloon-assisted coil embolization compared with stent-assisted coil embol ization obtained a higher degree of embolization, P<0.05; craniotomy clipping group had a higher incidence of hydrocephalus than embolization group, P<0.05.5The changes on the levels of the cerebrospinal fluid endothelin-1(ET-1), nitric oxide (NO) after subarachnoid hemorrhage (SAH)The treatment group CVS occurred in10patients (33.3%), the control group CVS occurred in17cases (56.7%), significant difference exist(P<0.05); the cerebrospinal fluid levels of ET-1on3days no significant difference (P>0.05)between control group and experimental group in after SAH, the2groups of ET-1levels increased with time (P<0.05), but the control group increased more significantly, the difference was statistically significant (P<0.05.) the NO levels of the cerebrospinal fluid control has no significant difference (P>0.05)between group and experimental group on3days after the SAH,, NO levels decrease with time in2groups (P<0.05), but the control group decreased more significantly, the difference was statistically significant (P<0.05).Conclusion1Patients with intracranial aneurysms are mostly women, mean age54years old or so, the most commom first symptom is headache, the most common site is anterior communicating artery aneurysm and posterior communicating artery. Hunt-hess grade had a significant effect on cerebral vasospasm and prognosis. The higher Hunt-hess grade is, the higher the incidence of cerebral vasospasm, the worse prognosis2Interventional treatment of intracranial very small aneurysms, wide-necked aneurysms, dissection aneurysms and fusiform aneurysms is safe and effective, incidence of intraoperative complications is low, but there is a certain degree of morbidity and mortality due to procedure-related complication.3The treatment methods of complex intracranial aneurysms involved in a simple coil embolization, balloon-assisted coil embolization, stent-assisted coil embolization, parent artery occlusion, liquid glue embolization. Intraoperative complications such as aneurysm rupture, thrombosis had no significant difference between balloon-assisted coil embolization and stent-assisted coil embolization.4Treatment of wide-necked bifurcation aneurysms with "Y"type stent is safe, but the procedure is difficult and requires high technical level.5After the treatment with Naomai Jiejing Tang, the cerebrospinal fluid levels of ET-1decreased in patients with SAH, while the NO level increased, the incidence of cerebral vasospasm decreased, which suggested that NaomaiJiejing Tang can prevent and treat CVS after SAH effectively...