颈内动脉血泡样动脉瘤的血管内治疗

Endovascular treatment of blood blister-like aneurysms in the internal carotid artery

目的研究计划性、分期血管内栓塞在颈内动脉血泡样动脉瘤治疗中的作用。方法回顾性分析6例颈内动脉血泡样动脉瘤病人的临床资料,Hunt-Hess分级Ⅰ级1例,Ⅱ级3例,Ⅲ级2例。首次治疗均采用单纯多支架植入,随访动脉瘤再通则辅助弹簧圈栓塞。结果初次术后动脉瘤完全栓塞2例,次全栓塞3例,不全栓塞1例。随访6～18个月,平均6.3个月。DSA显示动脉瘤再通3例,其中予再次辅助弹簧圈栓塞2例;行动脉瘤孤立及颈内动脉闭塞术1例,术后发生出血性脑梗死。术后6个月mRS评分:1分(恢复良好)5例,3分(恢复差)1例。结论颈内动脉血泡样动脉瘤先行单纯多支架植入,随访动脉瘤再通则辅助弹簧圈栓塞,是一种安全而有效的治疗方法。

Objective To research clinical efficacy of planned and staged endovascular treatment for blood blister-like aneurysms of the internal carotid artery. Methods Clinical data of 6 patients with blood blister-like aneurysms of the internal carotid artery were analyzed retrospectively, including 1 Hunt-Hess grade I, 3 grade Ⅱ and 2 grade m. Multiple-stent placements were performed for the initial treatment in all the patients, and coil embolization was used in recanalization cases during follow-up period. Results After initial surgery, complete embolization was achieved in 2 patients, subtotal embolization in 3 and partial embolization in 1. All the patients were followed up for mean period of 6.3 months, ranged from 6 to 18 months. DSA showed aneurysm recanalized in 3 patients. Coil embolization was performed in 2 of them and the other one received aneurysm trapping and parent vessel occlusion with hemorrhagic infarction postoperatively. The modified Rankin scores at 6 months were as follows： 1 score （good recovery） in 5 patients and 3 scores （poor recovery） in 1. Conclusions Multiple-stent placement for the initial treatment and coil embolization for recanalization cases during follow-up period is a safe and effective endovascular option for blood blister-like aneurysms of the internal carotid artery.