症状性脑动脉狭窄合并颅内动脉瘤的治疗策略和远期随访

Management of symptomatic cerebral arterial stenoses with coincidental intracranial aneurysms

目的探讨脑血管狭窄合并动脉瘤患者的临床特点及处理策略。方法总结2005至2011年南京大学医学院附属鼓楼医院通过脑血管造影确诊的中度以上动脉狭窄合并未破裂动脉瘤24例，把动脉瘤是否经过栓塞治疗分为A组（栓塞组）和B组（观察组），各12例。A组均行血管成形术并行动脉瘤栓塞。B组中7例仅对狭窄血管行血管成形术，未处理动脉瘤，其余5例仅给予控制危险因素，未给予介入和外科干预治疗。通过电话和门诊进行长期随访，10例患者复查了DSA。结果A组有1例患者出现了无症状支架内再狭窄，所有患者均未出现缺血或者出血症状。B组有2例患者死亡，死亡原因为蛛网膜下腔出血。结论对伴发的动脉瘤的脑动脉狭窄患者，血管成形或抗血小板均可能增加出血风险，条件允许下应对动脉瘤进行积极的栓塞治疗。

Objective To explore the clinical features and management strategies of patients with symptomatic intracranial stenosis associated with unruptured intracranial aneurysms. Methods From 2005 to 2011,24 patients of symptomatic intracranial stenosis with coincidental intracranial aneurysm were divided into two groups of angioplasty and aneurysm embolization （ A, n = 12 ） and non-embolization （ B, n = 12 ）. All patients were followed up by phone or at outpatient services. Ten patients were re-assessed with digital subtraction angiography （DSA）. Results The patients of group A were followed up without stroke or death, but one patient had restenosis asymptomatically. Two patients of group B died of subarachnoid hemorrhage. Conclusion Angioplasty or antiplatelet therapy may increase the rupturing risk of aneurysm. Dissecting aneurysms should be handled by coiling positively and in a timely manner by coiling to prevent rebleeding. Coincidental intracranial aneurysms should be handled by coiling actively.