载瘤动脉闭塞术治疗大脑后动脉夹层动脉瘤

Parent artery occlusion for treatment of posterior cerebral artery dissecting aneurysms

目的探索载瘤动脉闭塞术治疗大脑后动脉夹层动脉瘤的安全性和有效性。方法回顾性分析应用载瘤动脉闭塞治疗的大脑后动脉夹层动脉瘤患者23例。动脉瘤均位于大脑后动脉P2段或以远部位。临床随访应用GOS评分。结果23例患者手术均成功，无器械相关的并发症。其中4例术后出现并发症：再出血1例，轻偏瘫1例，偏盲2例。载瘤动脉完全闭塞的患者术后即刻造影显示动脉瘤和载瘤动脉完全闭塞。行姑息性闭塞治疗的5例中，1例死于术后再出血，其余4例随访DSA均显示动脉瘤有增大或复发。结论载瘤动脉闭塞术对于大脑后动脉P2段及以远的夹层动脉瘤治疗是安全有效的。

Objective To study the safety and efficacy of parent artery occlusion for the treatment of posterior cerebral artery dissecting aneurysms. Methods 23 patients with posterior cerebral artery dissecting aneurysms were treated via endovascular parent artery occlusion in our institution. All of the an^urysms were at P2 or distal segment of PCA. Glasgow Outcome Scale （GOS） was used to evaluate the clinical outcome. Results The procedure was technically successful in all cases. Four procedure - related complications occurred ： rebleeding （ n = 1 ）, hemiparesis （ n = 1 ）, and hemianopisia （ n = 2 ）. In the trapping group and the proximal occlusion group, all of the immediate angiography showed occlusion of the parent vessel and the aneurysm without retrograde filling＇ from collateral vessels. And follow - up imaging showed no recurrence of the aneurysms. In the palliative embolization group, one of five patients was died of rebleeding after the procedure. The follow - up DSA showed that the other four aneurysms recurred. Conclusions Deliberate parent artery occlusion with detachable coils appears to be well tolerated for P2 or distal segment of PCA dissecting aneurysms. The technique may be the first choice of treatment for the treatment of dissecting aneurysms ofposterior cerebral artery.