椎动脉夹层的影像诊断及血管内介入治疗(附19例报告)

Imaging of diagnosis and endovascular treatment of vertebral arterial dissection(report of 19 cases)

目的总结椎动脉夹层的影像诊断和评价血管内介入治疗方案的选择与效果。方法回顾性分析19例椎动脉夹层的影像学特点(CTA、DSA)。采用血管内介入椎动脉夹层19例:颅外段椎动脉夹层所致血管狭窄行支架成形术3例,颅内段夹层动脉瘤累及小脑下后动脉(PICA)采取支架结合弹簧圈栓塞4例,PICA位于夹层动脉瘤以远采取夹层动脉瘤及近端载瘤动脉闭塞12例。结果颅外段椎动脉夹层表现为血管腔狭窄、内膜瓣,颅内段椎动脉夹层的影像特点CTA表现为动脉瘤样扩张、壁内血肿等,DSA为珠线征、瘤样扩张等。术后造影:单纯支架置入病例狭窄消失;支架结合弹簧圈治疗病例动脉瘤腔消失,载瘤动脉通畅;血管闭塞病例显示椎动脉夹层均完全闭塞。术中未发生死亡、破裂出血及其它严重并发症,术后随访3-36个月,未发生再出血及缺血等并发症。结论 DSA及CT、CTA椎动脉夹层具有诊断价值;夹层动脉瘤的准确诊断对于介入治疗方案的选择至关重要;血管内介入治疗椎动脉夹层安全、有效、效果良好。

Objective To summarize experiences in imaging of diagnosis for vertebral arterial dissection （VAD） and effect of interventional therapeutic schedule. Methods Retrospective analysis of imaging features （computed tomography angiography CTA, digital subtraction angiography （DSA） of 19 cases of VAD, and corresponding interventional managements were reviewed. Endovascular interventional procedures were adopted in a total of 19 patients, including stent implantation alone in 3, stent-coil embolization in 4, and simple embolization proximal oclussion of parent artery and VAD in 12 infra-PICA （posterior inferior cerebellar artery） lesions. Results Imaging features of extradural hemorrhage VAD were lumen of blood vessel stenosis, intimal flap, imaging features of intradural hemorrhage VAD CTA were aneurysm like ex tention and intralumural hematoma, DSA was pearl and string sign or aneurysm like extention. Angiography after operation： stenosis disappeared after simple stent insertion; aneurysm disappear and parent artery were unobstructed after stent coil embolization; vascular occlusion cases demonstrated complete occlusions. No patient was died and no aneurysms were raputured and other severity complication during operation, no rehemorrhagia or ischemia were happened follow up 6-36 months. Conclusion DSA and CTA, CT have diagnostic value of VAD. Accurate diagnosis is very important for selecting right interventional thern. Interventional management is safe and effective choice for VAD.