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目的通过数字减影脑血管造影(DSA)对自发性蛛网膜下腔出血(SAH)作病因诊断及颅内动脉瘤的介入治疗。方法对246例SAH患者行DSA检查以明确其出血原因。对138例确诊动脉瘤患者用GDC或EDC行血管内栓塞治疗。结果246例SAH患者DSA检查发现颅内动脉瘤155例(63.0%),其中动脉瘤合并脑动静脉畸形(AVM)3例,动脉瘤合并烟雾病1例,AVM15例(6.1%),烟雾病10例(4.1%),高血压动脉硬化39例(15.9%),原因不明27例(11.0%)。138例颅内动脉瘤栓塞患者中1例术中出血死亡,1例术后1h再出血死亡;动脉瘤栓塞术后经DSA随访90例,随访时间为1个月至6.5年,发现13例再通(其中2例因再出血行DSA复查发现再通),再通率为14.4%,13例再通患者经再栓塞后未发生再出血。结论自发性SAH的主要原因是脑动脉瘤,DSA是明确SAH病因的可靠方法,GDC或EDC血管内栓塞治疗颅内动脉瘤安全有效,但有一定复发率,故应注意随访。
Objective To investigate the etiological diagnosis of spontaneous subarachnoid hemorrhage (SAH) and the interventional treatment of intracranial aneurysms by digital subtraction angiography (DSA). Methods 246 cases of SAH patients underwent DSA examination to determine the cause of bleeding. Of 138 patients with aneurysm diagnosed with GDC or EDC endovascular embolization. Results A total of 155 cases (63.0%) of intracranial aneurysms were found by DSA in 246 cases of SAH. There were 3 aneurysms combined with cerebral arteriovenous malformation (AVM), 1 aneurysm with moyamoya disease, 15 cases with AVM (6.1% 10 cases (4.1%), 39 cases of hypertensive arteriosclerosis (15.9%) and 27 cases (11.0%) of unknown cause. Among the 138 patients with intracranial aneurysm embolism, 1 died of intraoperative bleeding and 1 died of rebleeding at 1 hour after operation. 90 cases were followed up for DSA for 1 month to 6.5 years after embolization of aneurysm, and 13 cases were found (2 of which were recurred due to DSA after rebleeding), and the recanalization rate was 14.4%. No rebleeding occurred in 13 recanalization patients after re-embolization. Conclusions The main reason of spontaneous SAH is cerebral aneurysm. DSA is a reliable method to clarify the etiology of SAH. GDC or EDC is safe and effective in treating intracranial aneurysms with endovascular embolization. However, there is a certain recurrence rate and should be followed up.