颅内后循环远端动脉瘤的介入治疗

Interventional therapy for distal aneurysms of intracranial arteries in the posterior circulation

目的回顾性分析20例以电熔断解脱弹簧圈栓塞的后循环远端动脉瘤的治疗结果,探讨颅内动脉后循环远端动脉瘤的介入治疗方法与安全性。方法20例患者(其中18例以自发性蛛网膜下腔出血起病,2例以头痛起病)经造影证实大脑后动脉、小脑上动脉、小脑前下动脉、小脑后下动脉之远端动脉瘤分别为2例、4例、4例、10例。其中小脑上动脉供血之动静脉畸形1例,伴有血流相关破裂动脉瘤。小脑后下动脉远端多发动脉瘤1例。所有动脉瘤均采用GDC、EDC或Matrix弹簧圈栓塞。其中单纯栓塞动脉瘤2例;栓塞动脉瘤同时栓塞载瘤动脉18例。结果所有病例栓塞操作均顺利完成,无手术相关的死亡,术后出现一过性功能障碍2例;载瘤动脉栓塞后多数可见侧支供血,未见叫显的小脑供血减少。结论后循环远端动脉瘤由于动脉瘤特性、载瘤动脉细小、动脉瘤与载瘤动脉比例等因素,多需要闭塞载瘤动脉。为避免可能造成的侧支血管的闭塞,建议用弹簧圈栓塞。

Objective To retrospectively analyze the results of 20 patients with distal posterior circulation aneurysms treated by electrodetachable coils and discuss the therapeutic methods and safety. Methods 20 patients （subarachnoid hemorrhage or headache were found in 18 and 2 cases respectively） underwent digital subtract angiography. Distal aneurysms of posterior cerebral artery （PCA）, superior cerebellar artery （ SCA ） , anterior inferior cerebellar artery （ AICA ） and posterior inferior cerebellar artery （PICA） were found in 2, 4, 4 and 10 cases respectively. Among them, 1 was found as a blood-flow-relatedruptured aneurysm located on SCA feeding the arteriovenous malformation （AVM）. All the aneurysms were treated with GDC,EDC or Matrix coils,among which 2 were intra-aneurysmal embolized and 18 were intraaneurysmal embolized with proximal occlusion of the parent arteries. Results All procedures were successful without technique related death. Only 2 patients manifested with short-time cerebella disfunction. When the parent artery was occluded, most of cases appeared to collateral circulation and there were no blood flow descending in cerebella. Conclusion Most of the distal aneurysms in posterior circulation need to be embolized with parent arteries on account of the thin diameter of the parent arteries. We suggest that in order to avoid the possible collateral artery occlusion, coils should be adopted to make the aneurysms and parent artery embolization.