多支架技术治疗椎-基底动脉巨大夹层动脉瘤疗效分析

Multiple stent technique for the treatment of giant vertebrobasilar dissecting aneurysms:a clinical therapeutic analysis

目的探讨多支架技术治疗椎-基底动脉巨大夹层动脉瘤的技术要点及疗效。方法 2005年8月至2011年7月收治9例椎-基底动脉巨大夹层动脉瘤患者,瘤体最大径>25 mm,均经磁共振成像(MRI)、二维及三维DSA造影重建明确诊断,其中颅内段椎动脉病变7例,椎-基底动脉病变2例。根据椎-基底动脉夹层动脉瘤形态不同,选用双支架治疗7例,双支架辅助弹簧圈治疗1例,三支架治疗1例。结果术后即刻造影显示6例支架植入处血流发生明显改变,夹层扩张处缩小。术中无血栓事件及动脉瘤破裂出血,1例出现严重血管痉挛,对比剂滞留,应用罂粟碱后迅速缓解。随访时间为3个月至30个月,8例头晕病例中有7例症状消失或减轻,7例术前饮水呛咳病例症状消失4例,减轻2例,1例无变化。造影随访9例,双支架辅助弹簧圈治疗1例动脉瘤无再通;5例多支架治疗后夹层动脉恢复正常,另4例扩张部分明显变小。结论多支架技术治疗椎-基底动脉巨大夹层动脉瘤安全、有效,可以有效缓解相关症状。

Objective To discuss the technical points and to analyze the clinical efficacy of multiple stent technique in the treatment of giant vertebrobasilar dissecting aneurysms. Methods From August 2005 to July 2011, 9 patients with giant vertebrobasilar dissecting aneurysms were admitted to the hospital. The maximum diameter of the aneurysms was 〉 25 mm. The diagnosis was confirmed by MRI and DSA （2D and 3D reconstruction） in all patients. The lesions were located at the intracranial segment of vertebral artery （n = 7） or at the vertebrobasilar artery （n = 2）. According to the morphology of the dissecting aneurysm, double stent technique was used in 7 patients, double stent-assisted coil implantation technique was employed in one patient, and triple stent technique was adopted in one patient. Results Angiography performed immediately after stent implantation showed that in 6 patients the blood flow at stenting site changed markedly and at the same time the enlarged dissecting artery shrank obviously. Neither thromboembolic events nor intra-operative aneurysm rupture occurred. One patient developed severe vasospasm with retention of contrast agent, which was rapidly relieved after the use of papaverine. The follow-up time ranged from 3 months to 30 months. Of the 8 patients who had dizziness before treatment, the symptoms disappeared or were relieved in seven. Seven patients had choking cough due to drinking before treatment, after the treatment the symptoms disappeared in 4 cases, were relieved in 2 cases, and remained the same in one case. Follow-up angiography was performed in 9 patients, and it showed that no recurrence was seen in one case who had received double stent-assisted coil implantation treatment. The originally expanded dissecting arteries regained normal shape in 5 patients who had received multiple stents treatment, and the originally expanded dissecting arteries were obviously reduced in size in the remaining 4 patients. Conclusion For the treatment of giant vertebrobasilar dissecting aneurysms, multiple stent technique is safe and effective. This technique can effectively alleviate the related symptoms.