个性化血管内治疗椎动脉瘤分析

Analysis of vertebral artery aneurysm by personalized treatment

目的回顾性分析63例椎动脉瘤的个性化治疗经验。方法本组2000—2011年共收治63例患者(均已经DSA证实,共65个椎动脉瘤)为分析对象,其中41例伴瘤颈和载瘤血管闭塞的椎动脉瘤患者置入弹簧圈;12例未破裂的椎动脉瘤患者或对侧椎动脉发育不全的动脉瘤患者置入支架和弹簧圈;10例未破裂的VA-PICA动脉瘤患者或对侧椎动脉发育不全破裂的VA-PICA动脉瘤患者,单独行支架置入。运用改良Rankin量表(mRS)对临床结果进行评分。结果 63例中5例(7.9%)患者在30d的治疗过程中出现恶化,且导致其中3例患者死亡;57例(90.5%)患者,实现独立活动(mRS 0～2级);63例患者中44例(69.8%)进行血管造影随访,其中39例(88.6%)可确诊完全或基本完全的血栓形成,3例患者观察到病灶轻微减小,2例(4.5%)患者存在显著的残留病灶。结论椎动脉动脉瘤病人的个性化血管内治疗长期效果良好。

Objective To analyze the personalized treatment for 63 cases of vertebral artery aneurysms. Methods A total of 63 patients with 65 vertebral were reviewed from 2000 to 2011, 41 patients with neck and vertebral aneurysms distal were treated by coils; 12 patients with unruptured vertebral aneurysm or hypoplastic artery were treated by stents and coils; 10 pa- tients with unruptured VA-PICA or hypoplastic artery were treated by stents. The clinical outcome was evaluated by using the modified Rankin scale. Results The follow-up revealed that 57 patients （90.5%） in the mRS 0-2 category could realize inde- pendent activities; 5 patients （7.9%） grew worse in 30 days, of which 3 cases died. Angiographic follow-up data were obtained in 44 patients （69.8 %）. Complete or virtually complete thrombosis was confirmed in 39 cases （88.6 %）. A slight reduction in the size of the lesion was noted in 3 patients （4.8%） and there was a significant residual lesion in 2 patients （4.5%）. Conclu- sion The vertebral artery aneurysms can be well treated by personalized treatment.