颅内支架重叠技术治疗未破裂椎-基底动脉夹层动脉瘤

Intracranial stent overlaping in the treatment of unruptured vertebrobasilar dissecting aneurysms

目的探讨颅内支架重叠技术在未破裂椎-基底动脉夹层动脉瘤(VBDAs)治疗中的临床效果。方法回顾性分析10例VBDAs患者,共12个未破裂VBDAs。运用颅内支架重叠技术,采用LEO支架进行治疗(对9例患者采用2枚支架,1例采用3枚支架),通过改变动脉瘤腔的血流动力学栓塞动脉瘤,并保留载瘤动脉。所有患者均完成临床和影像学随访。结果①影像学检查表现分别为近端狭窄、串珠样变、波纹状、双腔征、壁间血肿。②术后即刻造影均显示,动脉瘤腔内对比剂滞留。1例患者术中支架移位,但未导致神经功能障碍。2例患者术后出现短暂性脑缺血发作,对症治疗后缓解。其余患者未出现神经系统并发症。出院前头部CT检查均未见新发脑梗死。③术后6个月造影结果显示,6个夹层动脉瘤完全闭塞,6个夹层动脉瘤部分闭塞。临床随访8～27个月,10例患者的最终改良Rankin评分均为0分,随访中患者均未出现该技术相关的并发症。结论颅内支架重叠技术治疗未破裂VBDAS是安全和有效的。

Objective To investigate the clinical effect and follow-up outcome of the intracranial stent overlapping technique in the treatment of unruptured vertebrobasilar dissecting aneurysms （VBDAs）. Methods Ten patients with VBDAs had 12 unruptured VBDAs were analyzed retrospectively. The patients were treated using intracranial stent overlapping technique and LEO stents （9 patients using 2 stents, 1 using 3 stents）. The aneurysms were occluded by changing the hemodynamics of the aneurysmal cavities, and the parent arteries were preserved. All the patients completed clinical and imaging follow-up study. Results ①Of the 10 patients with VBDAs, 7 had headache, 1 had ataxia, 3 had dizziness, and 1 had facial numbness, hnage exami-nation revealed proximal segment stenosis, string and pearl sign, wave shaped, double-lumen sign, and intra-mural hematoma, respectively. ②Angiography revealed contrast agent retention in the aneurysm cavity immedi- ately after stenting. Stent migration occurred in 1 patient, but it did not result neurological dysfunction. Two pa-tients had transient ischemia attack after stenting, it was relieved after symptomatic treatment. The remaining patients did not have any nervous system complications. Head CT scan before discharge did not revealed any new brain infarctions. ③Angiographic examination showed that 6 dissecting aneurysms were occluded completely at 6 months after stenting and the other 6 ones were occluded partially. The patients were followed up for 8 to 27 months, and the final mRS score was 0 in 10 patients. There were no technique-related complications in the pa-tients during the follow-up period. Conclusion Intracranial stent overlaping technique in the treatment of un-ruptured VBDAs is safe and effective.