变异的原始三叉动脉夹层动脉瘤的血管内治疗一例并文献复习

Endovascular therapy of persistent trigeminal arterial variant dissection:A case report and literature review

目的探讨夹层动脉瘤的发生机制及变异性原始三叉动脉(primitive trigeminal PTA)动脉瘤的血管内治疗。方法报道并分析我院治疗存在PTA并发夹层动脉瘤的病例;Medline数据库检索PTA动脉瘤及所有关于变异型原始三叉动脉(PTAV)的文献,行文献复习。结果通过闭塞夹层动脉瘤及PTAV本身的术式治愈患者,出院及1年随访的MRS评分均为0分。存在原始三叉动脉者颅内动脉瘤的发病率约为3%,其中动脉瘤发自PTA本身约占2%,见37例报道,其中2例为夹层动脉瘤。PTAV动脉瘤的发生率约为9.8%,其中夹层动脉瘤的发生率在PTAV组及PTA组分别为50%和5.4%。结论血管发育异常是除血流动力学因素以外的动脉瘤,特别是夹层动脉瘤的发病原因之一,在无其他并存血管异常时,闭塞载瘤动脉是对PTAV动脉瘤安全和有效的治疗方法。

Objective To investigate the mechanisms of the development of intraeranial dissection and the endovaseular treatment of PTAV aneurysms. Methods The eases with PTAV and PTAV aneurysms treated in our hospital, the literature involving PTA aneurysms and PTAV from Medline database and finally the literature review were carried out and comprehended. Results The occlusion method for the patients of our hospital with PTAV aneurysm and the aneurysm together with PTAV were successfully performed. The modified ranking scale（MRS）on the discharging day and 1 year follow up was 0. The prevalence of aneurysms in patients with PTA was 3%, and the aneurysms located on PTA itseff was only 2%, with 37 eases report including 2 dissection aneurysms. The prevalence of PTAV aneurysms was 9.8% including the incidences of dissection with PTAV and PTA were 50% and 5.4% respectively. Conclusions A defect harboured vessel is one of the mechanisms for developing aneurysm besides the hemodynamie stress, especially the dissection aneurysm. If there＇s no concomitant deficit in adjacent vessels, occlusion of the PTAV aneurysm together with the parent artery is rather safe and effeetive.