支架结合弹簧圈治疗破裂椎动脉夹层动脉瘤

Endovascular treatment of ruptured vertebral artery dissecting aneurysms with stents and coils

目的评估支架结合弹簧圈技术治疗破裂椎动脉夹层动脉瘤（VADA）的可行性、有效性和安全性。方法回顾性分析57例破裂VADA的临床资料,均使用支架结合弹簧圈技术治疗,按使用支架数量分为单支架组（n=32）和多支架组（n=25）,比较两组间即刻和随访的影像学结果及临床结果。结果治疗即刻VADA完全栓塞、近全栓塞和部分栓塞,单支架组分别为4例（12.5%）、7例（21.9%）、21例（65.6%）,多支架组分别为13例（52%）、7例（28%）、5例（20%）。影像学随访12~78个月,单支架组30例,其中VADA完全栓塞19例（63.3%）,显影11例;多支架组24例,其中VADA完全栓塞23例（95.8%）、显影1例。术后即刻与随访期VADA完全栓塞率,多支架组显著高于单支架组（P〈0.05）。死亡3例。改良mRS评分在两组间差异无统计学意义（P〉0.05）。结论长期随访结果显示,支架辅助栓塞治疗破裂椎动脉夹层动脉瘤在技术上是安全有效的,多支架结合弹簧圈栓塞可有效提高即刻及远期的完全栓塞率,降低术后复发及再出血风险。

Objective To evaluate the feasibility,efficacy and safety of stent assisted coiling for ruptured intracranial vertebral artery dissection aneurysms（VADA）.Methods Clinical features of 57 ruptured VADA were retrospectively analyzed.Stent-assisted coiling was performed in all the patients.According to number of stents,the patients were grouped into single-stent group（n = 32） and multiple-stent group（n = 25）.The difference was compared between the two groups on angiographic and clinical results.Results The instant results of radiography revealed total occlusion of the VADA was achieved in 4（12.5%） and 13（52%） patients,near total occlusion in 7（21.9%） and 7（28%）,and partial occlusion in 21（65.6%） and 5（20%） in single-stent group and multiple-stent group respectively.Thirty patients in single-stent group and 24 in multiple-stent group were angiographically followed up for 12-78 months.A total occlusion and subtotal occlusion were seen in 19（63.3%） and 11 patients in single-stent group,and in 23（95.8%） and 1 patient in multiple-stent group.The complete occlusion rates immediately postoperation and during follow-up period were significantly higher in multiple-stent group than in single-stent group（P ＆lt; 0.05）.Three patients died.There was no difference in modified Rankin score between the single-stent group and multiple-stent group（P ＆gt; 0.05）.Conclusions Stent-assisted coiling is safe and effective for ruptured intracranial VADA,which is confirmed by long-term follow-up.Application of multiple overlapping stents is effective to elevate the rate of total occlusion,and to reduce the risk of recurrence and rebleeding.