血管内治疗椎动脉夹层动脉瘤18例

Endovascttlar management of vertebral dissecting aneurysms

目的 探讨椎动脉夹层动脉瘤的发病机制,评价血管内治疗椎动脉夹层动脉瘤的技术方法及临床疗效。方法 应用血管内治疗技术对18例椎动脉夹层动脉瘤的患者进行诊断、治疗,回顾性分析临床资料、血管内治疗经过以及临床疗效。 结果 18例患者中有6例直接闭塞动脉瘤和载瘤动脉,7例行支架辅助弹簧圈栓塞,4例行双支架置入术,1例单纯闭塞载瘤动脉。术后12例患者接受随访,随访时间为3个月至2年,平均8个月。随访期间曾经有过蛛网膜下腔出血的7例患者临床症状减轻或消失,没有再出血,2例术后临床症状未见改善。18例患者中3例死亡。 结论 血管内治疗椎动脉夹层动脉瘤最有效的方法,是将载瘤动脉连同动脉瘤完全闭塞,如果动脉瘤位于优势椎动脉,或对侧椎动脉发育不良甚至闭塞,或动脉瘤瘤体发出优势小脑后下动脉,应该使用支架血管成形辅助弹簧圈填塞动脉瘤或双支架置入技术。

Objective To discuss the pathogenesis and evaluated the endovascular treatment management of vertebral dissecting aneurysms. Methods 18 patients with dissecting aneurysms were confirmed angio-graphically, and accepted endovascular treatment from August 2001 -March 2004, The clinical presentations, endovascular procedure, as well as clinical results were reviewed. Results 10 of 18 patients were male and 8 were female, aged from 32 to 65 years old (average: 46 years old). Lesion located at one side were 14 cases, the other were bilateral lesions. Initial clinical presentation included SAH in 8 cases, vertebrobasilar ischemic symptoms in 9 cases ( of these 3 cases presented with brain stem mass effect), and headache in 2 cases. All these cases accepted endovascular treatment under general anesthesia, the method included proximal occlusion of parent artery for 1 case, proximal and distal occlusion of parent artery plus embolization aneurysm for 6 cases, stent-assistant coil embolization for 7 cases, and double stents technique for 4 cases. 12 patients were followed-up angiographically from 3 months to 2 years ( average 8 months), 7 cases got good clinical results, no recurrentce of SAH, those with ischemic symptoms recovered within 2-3 weeks. After endovascular treatment, 2 cases had no change and 3 cases dead. Conclusion Complete occlussion of the vertebral dissecting aneurysm and its parent artery is the best endovascular method for vertebral dissecting aneurysm, the other effective methods including double stent method and stent assistant coil embolization.