小脑后下动脉远端动脉瘤破裂的血管内治疗

Endovascular treatment of ruptured distal posterior inferior cerebellar artery aneurysms

目的总结小脑后下动脉（posteriorinferiorcerebellarartery，PICA）远端动脉瘤破裂的临床特征及血管内治疗方法。方法回顾性分析11例破裂PICA远端动脉瘤病人的临床资料。术前Hunt—Hess分级：Ⅰ级1例。Ⅱ级5例，Ⅲ级4例．Ⅳ级1例。全部以单纯弹簧圈行血管内治疗。结果单纯闭塞动脉瘤7例，同时闭塞动脉瘤及载瘤动脉4例。所有病人随访1～4年，术后2年复发1例，再次行血管内治疗；术后1年载瘤动脉再通1例，但仍未见动脉瘤复发；余9例动脉瘤均栓塞完全。术后1年改良rankin评分（modifled rankin scale，MRS）：0分2例，1分8例，2分1例。结论对于PICA远端动脉瘤，以单纯弹簧圈闭塞动脉瘤或者同时闭塞动脉瘤和载瘤动脉均可行、且安全，能有效预防短、中期再出血，但需定期DSA随访以防复发。

Objective To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery （PICA） aneurysms. Methods Clinical data of 11 patients with ruptured distal PICA aneurysms were analyzed retrospectively, including grade Ⅰ in 1 patient, grade Ⅱ in 5 patients, grade Ⅲ in 4 and grade IV in 1. All the patients were treated by endovascular treatment with coiling alone. Results Embolization alone of aneurysm was achieved in 7 patients, and embolization of aneurysm and parent artery occlusion at the same time in 4. All the patients were followed up for 1 to 4 years. Recurrence occurred in 1 patient 2 years after surgery, who was retreated by endovascular treatment. The occluded parent artery of 1 patient was recanalized 1 year after surgery without recurrence ofaneurysm. The other 9 aneurysms were completely embolized. The modified rankin scale score 1 year after surgery was 0 in 2 patients, 1 in 8 and 2 in 1. Conclusions The embolization of ruptured distal PICA aneurysms by coiling with or without parent arteries occlusion is feasible, relatively safe, and can effectively prevent short and medium term rebleeding. Regular DSA follow-up is necessary to find and treat recurrence.