The Clinical Comparative Study On The Treatment Of Internal Carotid Artery-posterior Communicating Artery Aneurysm Microsurgery Surgical Clipping And Endovascular Interventional Therapy

Carotid artery-posterior communicating artery aneurysm occurred the first of the highest rate of intracranial aneurysms with the development of neurosurgery technology and equipment, improved pterional microsurgery surgical clipping of the carotid artery-posterior communicating artery aneurysm has beenneurosurgeon, the risk of surgery continued to decline, the quality of life of patients significantly improved. However, despiting these advances, only a relatively small number of patients return to a normal lifestyle after aneurysm rupture, many patients are left over from permanent neurological dysfunction or cognitive impairment. Endovascular intervention the treatment of carotid artery-posterior communicate artery aneurysm in recent years, rapid development, clipping as a micro-surgery to replace the safety and efficacy of the treatment has been proven, mature technology, a wider clinical indications, clinical results good, reducing the risk of aneurysm rupture and avoiding a craniotomy. Studying the internal carotid artery-communicating artery aneurysm with a different timing-of surgery, surgical approach, and how to reduce the incidence of postoperative complications, and thus obtaining optimal clinical effect is particularly important in order for patients to choose more favorable treatment programs.Objective:To explore the internal carotid artery-posterior communicating artery aneurysm (Posterior communicating artery, PcoA) microsurgery surgical clipping, and vascular interventional treatment in different age groups, the clinical classification and time of onset, prognosis for patients and doctors to provide the choice of how the clinical basis of surgical treatment.Methods:A retrospective analysis of217cases of internal carotid artery. Shanghai Huashan Hospital affiliated Fudan University and Chinese Medicine Hospital in Zhengzhou City, admitted from January2010to June2011-the posterior communicating artery aneurysm cases. They was used SPSS statistical software analysis, the wilcoxon test. Comparison of the two methods in patients with overall mortality and morbidity; comparison of the two methods the prognosis of patients with different preoperative Hunt-Hess grade; the prognosis of the comparison of the two methods at different ages:comparison of the two methods in the different timing of surgery prognosis; residual contrast aneurysm neck, recurrence, rebleeding and surgical methods.This group of217patients with cerebral angiography, three-dimensional reconstruction of the parallel relationship clear aneurysms of the carotid artery-posterior communicating artery and its branches in three-dimensional space. According to the aneurysm shape, size, patient age, preoperative Hunt-Hess grading of internal carotid artery-posterior communicating artery, the patients’family-members and I choose a treatment program.Wing points, or expand the pterional microsurgery surgical clipping of internal carotid artery-posterior communicating aneurysm in this group of97patients, including two cases associated with cerebral artery aneurysms.1cases of combined anterior communicating artery aneurysm, both over the same period microscopic surgical clipping of the middle cerebral artery aneurysm and anterior communicating artery aneurysm clipping of100aneurysms.107routine intravascular interventional treatment:62cases of narrow-necked aneurysms using a simple micro-coil embolism,41cases of wide-necked aneurysms using stent-assisted micro-coil embolism, balloon-assisted micro-coil embolism,4cases of giant aneurysm using a simple multi-stent, which combined with3cases of anterior communicating artery aneurysm associated with cerebral artery aneurysm-in2cases of bilateral internal carotid artery-posterior communicating aneurysm cases, both at the same embolism of all aneurysms, embolism of the aneurysm113;13patients had conservative treatment alone (due to the patients and family reasons). Postoperative follow-up modified Rankin score, the rate of rebleeding, and review of39cases of microsurgery in patients with surgical clipping and87cases of endovascular intervention in patients with cerebral angiography, and interventional treatment of patients with42cases of microsurgery in patients with surgical clipping and13cases of intravascular review of the CTA.Results:Endovascular treatment group, postoperative recovery was good (modified Rankin score0-2points), and101cases, functional disability (modified Rankin score3-5) and4cases and2deaths; micro-surgery group good recovery (modified Rankin scoring0-2) of83cases, functional disability (modified Rankin score3-5) in11cases,3cases died. Follow-up blood vessels in patients treated with107cases, cerebral angiography or CTA evidence of aneurysm neck after embolism residual3cases of aneurysm recurrence in five cases, including bleeding in1case; follow-up of97cases of micro-surgery patients, cerebral angiography, or CTA neck residues in seven cases, aneurysm recurrence,1case no rebleeding.13cases were conservatively treated patients,5patients died of rebleeding (2w-11m).Conclusion:Communicating artery aneurysm rupture of the internal carotid artery-should be preferred endovascular interventional therapy, and early surgery (<3d).Carotid artery-posterior communicating artery aneurysm rupture,3-14d hospitalized patients should try to choose the endovascular treatment of postoperative anti-vasospasm treatment. At the same time as the patient age and preoperative Hunt-Hess grading increase regardless of microsurgery surgical clipping or endovascular interventional treatment, post-operative morbidity and mortality rates are increased accordingly, but with the patient age and preoperative Hunt-Hess grade increases,endovascular treatment is the more obvious advantages. Microsurgery surgical clipping residual neck recurrence is superior to endovascular treatment.