Clinical Research On The Diagnosis And Interventional Therapy Of Anterior Communicating Artery Aneurysms

Objection:1.Subarachnoid hemorrhage(SAH)caused by the rupture of intracranial aneurysm is a main death cause in all cerebral hemorrhage,and anterior communicating artery is a predilection site of intracranial aneurysm.Earlier and accurate diagnosis and treatment have consideration meaning of preventing aneurysm rupture and decreasing the disability and mortality induced by SAH.This article through measuring the angle of internal carotid artery C1 segment and anterior cerebral artery A1 segment(C1A1 angle)on standard Town's position,explored the significance of measuring C1A1 angle in interventional therapy,to direct interventional therapy of cerebral anterior communicating artery aneurysms;2.On standard lateral projection of brain artery DSA images,made lines through the anterior border of internal carotid artery's petrous segment(C5)and the anterior border of anterior cerebral artery's vertical segment(A2),that is BD line,which divided anterior communicating artery aneurysms into two types:one under the BD line(anterior inferior type)and the other up the BD line(posterior superior type).Explored the significance of this categorization for interventional and surgery therapy.3.Further explored new advancement of interventional therapy of anterior communicating artery aneurysms.Material and methods:1.30 anterior communicating artery aneurysms patients who received final diagnosis and interventional therapy during June,2004 - December, 2007.They were divided into two groups randomly.For A group,control group(15 cases),we didn't measure C1A1 angle and shaped micro catheter and micro guide wire before interventional therapy,recorded operation time and observed postoperative complications after the operation;For B group,experimental group(15 cases),we measured C1A1 angle on standard Town's position before interventional therapy and shaped the micro catheter and micro guide wire according to the C1A1 angle,then did the same as A group.2.Summarized 30 cases of anterior communicating artery aneurysms angiography retrospectively,on standard lateral projection of brain artery DSA images,made BD line through the anterior border of internal carotid artery petrous segment(C5)and the anterior border of anterior cerebral artery vertical segment(A2),we divided 30 anterior communicating artery aneurysms into two types:under and up the BD line.Performed microsurgery after angiography.3.The patients were treated under general anaesthesia and heparinization. All the patients were treated by femoral puncture intubation with Seldinger's method. Routine prepared before operation and gave Nimodipine 0.5 hour in advance,to avoid cerebral angio spasm during operation.At first performed aortocranial angiography,then selected ideal images,measured the anterior communicating artery aneurysms and aneurysms neck size by different diameters.Measured C1A1 angle on standard Town's position.Selected standard lateral projection images, divided anterior communicating artery aneurysms into anterior inferior type and posterior superior type by BD line.Aneurysms and aneurysms carried arteries were embolimed with different patterns of coils and/or aneurysms neck aid equipment. After the operation,moved the catheter introducer 3 hours later,pressed for 6 hours, the correlate lower limb kept motionless for 24 hours and gave antibiotic in three days.Results.Analyzed the materials.1.the operation time,A group 2.43±0.52 hours, and B group 1.77±0.51 hours,the operation time of experimental group was obviously less than the control group(P＜0.05).2.According to the factors of the aneurysms,such as location,shape,size,and combining the Hunt-Hess grading, analyzed the therapy indication of the two group patients.Analyzed the curative effect according to GOS grading when the patients left hospital.Result demonstration: Appraises the curative effect by GOS grading,4 level and 5 level were satisfactory. The treatment satisfaction rate of A group was 53.3%,the case fatality ratio was 13.3%;The treatment satisfaction rate of B group was 93.3%,the case fatality ratio was 0%.3.According to standard lateral projection of brain artery DSA images,made BD line through the anterior border of internal carotid artery petrous segment(CS)and the anterior border of anterior cerebral artery vertical segment(A2),the 30 cases of anterior communicating artery aneurysms were divided into two types by BD line: The anterior inferior type included 20 cases;the posterior superior type included 10 cases.After surgery,the prognosis of the anterior inferior type was satisfied.But in the other type,one died,one was vegetative state,and others almost had different degrees of residual.Conclusion:1.Through analyzing two groups,compared to the control group,the operation time was obviously decreased,by measuring the C1A1 angle and shaping the micro catheter and micro guide wire in advance;the satisfaction rate of the operation raised obviously;the case fatality rate is lower than the control group. Before interventional therapy,measuring C1A1 angle will increase the achievement ratio and decrease complication and mortality.2.The C1A1 angle and the operation time have minus linear correlation,in other word,the smaller the C1A1 angle is,the longer the operation time is.If the C1A1 angle was smaller than 70°,interventional therapy became more difficult.3.For the anterior inferior type aneurysms,the aneurysms body close to the tuberculum sellae and the optic nerve,no important frail organizational structure surround,so the surgery was relatively easy.Clips could be placed to anterior communicating artery,it did not lead the carrying aneurysms artery to twist or ischemia,and the operation was simple,the prognosis was better.For the posterior superior type aneurysms,the aneurysms body close to the anterior cerebral artery,cerebral ganglion and saddle area,so the surgery was hard,and it usually lead the carrying aneurysms artery to twist or ischemia,the prognosis was bad.