破裂颅内椎动脉动脉瘤的血管内介入治疗

Endovascular treatment of ruptured intracranial vertebral dissecting aneurysms and fusiform aneurysms

目的探讨血管内介入治疗在破裂颅内椎动脉夹层及梭形动脉瘤中的应用。方法回顾性分析21例血管内介入治疗的颅内椎动脉夹层及梭形动脉瘤患者，其中8例采用微弹簧圈或球囊进行载瘤动脉闭塞术，13例应用支架辅助弹簧圈进行栓塞治疗。结果8例载瘤动脉闭塞的患者，载瘤动脉完全闭塞，小脑后下动脉保持通畅；随访3—12个月，未遗留明显的神经功能障碍。13例支架辅助弹簧圈栓塞的患者，术中1例因再出血死亡；余12例中，致密栓塞10例，接近完全栓塞2例。9例患者（包括接近完全闭塞的2例患者）有效造影随访3-11个月，致密栓塞的患者中动脉瘤无复发，载瘤动脉及PICA保持通畅；接近完全闭塞的2例患者中有1例部分复发，给予再次致密栓塞，另1例达稳定状态；另3例电话随访，未发现遗留明显的神经功能障碍。结论载瘤动脉闭塞术治疗破裂的椎动脉梭形及夹层动脉瘤效果肯定，但有潜在缺血的风险；支架辅助弹簧圈栓塞术近期效果较好，但远期疗效有待长期随访的验证。

Objective To evaluate the endovascular treatment of intracranial vertebral dissecting aneurysms and fusiform aneurysms. Methods We report a retrospective analysis of 21 aneurysms which underwent endovascular treatment, 8 aneurysms performed by occluding parent artery with coils or balloons, 13 aneurysms performed by using stent-assisted coiling. Results Eight patients were treated by complete occlusion of the parent artery, the posterior inferior cerebellar arteries were kept patency ; Follow-up performed in 8 patients from 3 months to 12 months revealed no neurological deficits. Thirteen patients were treated stent-assisted coiling. One was dead because of rebleeding during operation. Immediate angiographic outcomes were complete occlusion （10 patients）, nearly complete （2 patients）. Angiographic follow-up in 9 patients （ including 2 patients of nearly complete occlusion ） and telephoning follow-up in 3 patients were available at 3 to 11 months. 7 aneurysms of complete occlusion did not recur, the parent arteries and important branch vessels were kept patency ; One aneurysm of nearly complete occlusion recurred partly and then recoiled again. The other aneurysm remained nearly complete occlusion but stable; another three patients left no obvious neurologic deficits. Conclusions Occluding parent artery and stent-assisted coiling are the two available methods of endovascular treatment of ruptured intracranial vertebral dissecting and fusiform aneurysms. , but the choice of treatment should be individually. The sacrifice of one vertebral artery, so stent-assisted coiling that restores the patency of parent artery may be a better choice. The effect of occluding parent artery for ruptured intracranial vertebral dissecting and fusiform aneurysms was confirmed, but it has a potential risk of ischemia ; Stent-assisted coiling has a better outcome in the near future, but the long-outcome remained to be confirmed.