椎基动脉夹层动脉瘤支架应用探讨

Endovascular stent exclusion in treatmont of vertebra-basilar arterial dissecting aneurysm

目的探讨椎基动脉夹层动脉瘤支架应用的价值。方法12例椎基夹层动脉瘤,其中椎动脉3例,椎基动脉6例,基底动脉3例。2例动脉瘤位于小脑后下动脉处,各置入2枚支架,重叠在动脉瘤段载瘤动脉内,10例经支架网眼送入弹簧圈。结果12例置入支架16枚,7例填塞致密,3例疏松填塞,栓塞临床症状消失。6例在术后分别随访6～48个月,脑血管造影复查见动脉瘤消失。但有2例出现新的动脉瘤,1例在置入支架上段出现夹层动脉瘤,再次置入支架和1枚弹簧圈栓塞,动脉瘤消失,1例在原动脉瘤对侧动脉壁出现动脉瘤,再置入1枚支架重叠在原支架内,造影动脉瘤血液循环慢。2例小脑后下动脉夹层动脉瘤,24个月造影复查见动脉瘤缩小70%,小脑后下动脉瘤循环良好。其余4例因无症状不同意复查血管造影,遂行MRA、CTA检查,未见动脉瘤复发。结论支架辅助弹簧圈治疗椎基夹层动脉瘤是行之有效的方法。

Objective To study the therapeutic effects of endovascular stent exclusion on vertebra-basilar arterial dissecting aneurysms. Methods The clinical data of 12 cases of vertebra-basilar arterial dissecting aneurysms including 3 aneurysms of vertebral artery, 6 of vertebra-basilar artery, 3 of basilar artery were analyzed. Among them, 2 aneurysms involved PICA were treated with dual stents for each overlapping in the parent arteries of the aneurysms, and other 10 aneurysms were treated by coil assisted stents. Results 16 stents were used in all patients resulting with 7 aneurysms densely packed, 3 partially packed together with disappearance of clinical symptoms. Follow up of 6 - 24 mon in 6 cases . showed disappearance of aneurysms. But occurrence of new aneurysms were found in 2 cases and again cured by stenting. Aneurysms of PICA in 2 cases shrank about 70% after 2 years of stent placement. The rest 4 cases were followed up with MRA/CTA, demonstrating no recurrence. Conclusion Coil assisted stent is the optional treatment with reliable efficacy for the vertebra-basilar dissecting aneurysms.（J Intervent Radiol, 2007, 16： 436-438）