颅内动脉夹层与夹层动脉瘤的诊治探讨

Diagnosis and treatment of intracranial arteries dissections and dissecting aneurysms (report of 67 cases)

目的探讨颅内动脉夹层与夹层动脉瘤的临床特点,评价血管内栓塞疗效及安全性。方法 2003年12月至2011年12月共收治67例颅内动脉夹层与夹层动脉瘤。50例采用血管内治疗,其中单纯支架置入32例,单纯微弹簧圈栓塞3例,支架辅助微弹簧圈栓塞14例,微弹簧圈加真丝线段栓塞1例;17例未行外科治疗。结果 CTA及MRA造影随访28例,DSA造影随访20例,42例病人恢复良好,1例术后3 d再次出血死亡,4例复查见椎动脉闭塞,1例遗留进食呛咳;未治疗17例中,4例住院期间又突然发生出血死亡。结论采用支架置入重建受累血管的真腔、闭塞假腔是血管内治疗颅内动脉夹层与夹层动脉瘤的主要方法。

Objective To investigate the clinical characteristics of intracranial arteries disseetions（IAD） and dissecting aneurysms （DA） and assess the safety and outcomes of their endovaseular treatment. Methods The clinical data and following up outcomes of 67 patients with IAD and DA, who were treated in our hospital from December, 2003 to December, 2011, were analyzed retrospectively. Of 50 patients underwent the endovascular embolization, 32 were treated by the stent placement, 3 by the embolization with coils, 14 by stenting and coiling and 1 by the embolization with coils and silk suture. Seventeen patients were conservatively treated. Results Of 48 patients followed up or from 3 months to 7 years, 42 were recovered well, 4 had occluding vertebral arteries, 1 choked and coughed while eating and 1 died of rebleeding 3 days after the operation. Four of 17 patients receiving conservative treatment died. Conclusions The aim of interventional therapy is reconstruction of the true lumen of the involved artery and occluding the dissections in the patients with IAD and DA. Stent deployment is the major method to reconstruct the true lumen of the involved artery.