破裂出血的椎动脉夹层动脉瘤早期血管内治疗经验

Early management of ruptured intracranial vertebral dissecting aneurysms

目的探讨早期血管内介入等综合方法治疗破裂出血的椎动脉夹层动脉瘤的临床效果。方法根据椎动脉夹层动脉瘤形态选用不同方法共治疗14例，其中支架辅助弹簧圈技术治疗6例，双支架治疗4例，动脉瘤及载瘤动脉闭塞治疗4例。术后尽早将血性脑脊液排出，同时防治血管痉挛。结果术中无栓塞及动脉瘤破裂等并发症。除1例Hunt—HessV级患者死亡外，其余13例均恢复良好。平均随访16个月，无再出血。影像随访13例，支架辅助弹簧圈治疗者仅有1例部分再通；2例双支架治疗患者原扩张已消失，另2例扩张部分明显变小。3例动脉瘤及载瘤动脉闭塞无再通。结论早期血管内介入治疗破裂出血的椎动脉夹层动脉瘤是安全有效的。根据夹层动脉瘤不同的形态特征，可以选择不同的方法。

Objective To evaluate the early management of intracranial vertebral dissecting aneurysms. Method The ruptured intracranial verterbral dissecting aneurysms have been treated early since August 2005 according to their specific configuration by three endovascular techniques. 6 aneurysms were treated by stentt - assisted coiling;4 aneurysms were treated by double stents technique ;4 aneurysms were treated by aneurysm and parent artery coiling. Bloody cerebrospinal fluid was drained as early as possible after endovascular treatment, together with calcium channel blockers to prevent cerebral vasospasm. Results There was no embolic or bleeding complication during the operations. 13 patients recovered well, except that one patient who harbored Hunt＆Hess V died due to initiated severe brain damage. Follow - up 16 months, there is no rebleeding. Angiographic follow - up,6 anerysms treated by stent - assisted coiling except one who had partial recanalization did not recur. In 4 aneurysms treated by double stentts technique, the fusiform ectasia portion of two aneurysms disappeared and remarkably diminished in another two aneurysms. 3 aneurysms treated by aneurysm and parent artery coiling have no recanalization. Conclusions Early endovascular treatment of ruptured vertebral dissecting aneurysms is safe and effective. According to morphologic characteristics of aneurysm,it is better to choose a suitable technique such as stent- assisted coiling.