血管内介入治疗椎动脉夹层动脉瘤的疗效分析

Effect of endovascular treatment for disecting vertebral artery aneurysms

目的:评价血管内介入治疗椎动脉夹层动脉瘤的技术方法及临床疗效。方法:应用血管内介入治疗技术对29例椎动脉夹层动脉瘤的患者进行治疗,回顾性分析临床资料、血管内治疗方法以及临床疗效。结果:29例患者中有19例直接闭塞动脉瘤和载瘤动脉,5例行支架置入,5例行支架辅助弹簧圈栓塞。术后21例患者接受随访,随访时间为3～24个月,平均8个月。其中14例闭塞动脉瘤和载瘤动脉患者复查示动脉瘤未显影,3例支架辅助弹簧圈栓塞患者中1例复发,2例单支架置入患者复查示1例动脉瘤完全消失而另1例仍有动脉瘤残留,2例双支架置入患者复查示1例动脉瘤完全消失,另1例动脉瘤缩小。结论:将载瘤动脉连同动脉瘤完全闭塞是血管内治疗以破裂出血起病的椎动脉夹层动脉瘤最有效的方法。如果动脉瘤位于优势椎动脉,或动脉瘤体累及小脑后下动脉,使用支架置入技术是可供的选择。

Objective：To evaluate the procedures and clinical effect of vertebral dissecting aneurysms by endovascular treatment.Method：Twenty-nine patients with dissecting aneurysms were confirmed angiographically,and accepted endovascular treatment from September 2007 to June 2010.The clinical presentations,endovascular procedures,as well as clinical results were retrospectively reviewed.Result：The method included occlusion of parent artery plus aneurysm embolization for 19 cases,stent-assistant coil embolization for 5 cases,and stent technique for 5 cases.21 patients were followed-up angiographically from 3 months to 2 years（average 8 months）.Among 14 patients with internal trapping,there was no recurrence of aneurysms.Among 2 patients with stent-assisted embolization,one aneurysm showed recurrence.Among 2 patients with single stent implantation,one aneurysm showed residue,while one aneurysm disappeared.Among 2 patients with double-stent implantation,one aneurysm diminished,while one aneurysm disappeared.Conclusion：Complete occlusion of the vertebral dissecting aneurysm and its parent artery is the best endovascular method for vertebral dissecting aneurysm.If aneurysms located at dominant vertebral artery,or involved the posterior inferior cerebellar artery,the other methods including double stent method and stent assistant coil embolization may be effective.