血管内带膜支架技术治疗椎动脉夹层动脉瘤及颈内动脉海绵窦瘘

APPLICATION OF ENDOVASCULAR COVERED STENT FOR TREATING VERTEBRAL DISSECTING ANEURYSM AND CAROTID-CAVERNOUS FISTULA

目的探讨血管内带膜支架治疗椎动脉夹层动脉瘤和颈内动脉海绵窦瘘(carotid cavernous fi stula,CCF)的临床疗效。方法2006年3月-2007年5月,采用Jostent带膜支架治疗4例椎动脉夹层动脉瘤以及3例CCF。患者均为男性。椎动脉夹层动脉瘤患者年龄37～57岁;左侧3例,右侧1例。主要症状为突发头痛、呕吐;头部CT均示蛛网膜下腔出血;病程2 d～10年。CCF患者年龄35～51岁;左侧2例,右侧1例。主要症状为头痛,一侧眼球突出、胀痛,球结膜充血伴视力下降;1例有反复鼻腔大出血病史;出现症状前2 d～1个月均有头部外伤史;病程1周～2个月。结果椎动脉夹层动脉瘤均完全闭塞,椎动脉保持通畅,附近小脑后下动脉及小脑前下动脉保持通畅;无手术相关并发症发生。4例均获随访,随访时间8个月～2年,无症状复发及颅内再出血。CCF患者瘘口均完全闭塞,颈内动脉保持通畅;术后3 d患者眼球突出及球结膜充血表现均明显改善。3例均获随访,随访时间1～3个月;患侧视力均有不同程度改善。结论血管内带膜支架是治疗椎动脉夹层动脉瘤和CCF的有效方法之一。

Objective To investigate the therapeutic effects of endovascular covered stent on vertebral dissecnng aneurysm and carotid-cavernous fistula （CCF）. Methods From March 2006 to May 2007,Iostent coronary stent grafts were used to treat 4 patients with vertebral dissecting aneurysm and 3 patients with CCF. The patients of vertebral dissecting aneurysm were male and 37-57 years old, the lesion was located on the left vertebral artery in 3 patients and on the right vertebral artery in 1 patient, with the primary symptoms of sudden headache and vomiting; CT scan demonstrated subarachnoid hemorrhage; and the medical history varied from 2 days to 10 years. The patients of CCF were male and 35-51 years old, the lesion was located on the left carotid artery in 2 patients and on the right carotid artery in I patient, with the primary symptoms of headache, lateral exophthalmos, eyeball distending pain, conjunctive hyperemia and impaired eyesight; all 3 patients got head injury 2 days to 1 month before the appearance of symptoms and 1 of them had a history of severe nosebleed; and the medical history ranged from 1 week to 2 months. Results For the patients with vertebral dissecting aneurysm, complete obliteration of aneurysms was achieved, the circulations of the vertebral artery, the adjacent posterior inferior cerebellar artery and the adjacent anterior inferior cerebellar artery were smooth, no complications relative to operation occurred, and no recurrence of symptoms and intracranial rehaemorrhagia were observed during the follow-up period of 8 months-2 years. For the patients with CCF, the fistula were completely obliterated, the circulation of carotid artery was smooth, the exophthalmus and conjunctiva hyperemia were improved obviously 3 days after operation, the eyesight of patient was improved at different levels over the follow-up period of 1-3 months. Conclusion Endovascular covered stent is a new and useful tool for the treatment of vertebral dissecting aneurysm and CCF.