电解脱弹簧圈联合机械微弹簧圈治疗硬膜内出血性椎动脉夹层四例报道

Endovascular management of intradural hemorrhage vertebral artery dissection with guglielmi detachable coils and mechanical coils

目的初步探讨电解脱弹簧圈联合机械微弹簧圈血管内治疗硬膜内出血性椎动脉夹层的疗效。方法选择日照市人民医院自2008年1月至2011年12月连续4例经DSA确诊的硬膜内出血性椎动脉夹层患者，病变均位于小脑下后动脉近端，结合影像学及临床资料评估后经血管内栓塞治疗。选用电解脱弹簧圈致密栓塞夹层段椎动脉，机械弹簧圈栓塞夹层近端椎动脉。结果术中未发生死亡、破裂出血及其它严重并发症，术后即刻造影检查4例椎动脉夹层均完全闭塞，随访6-36个月，未发生再出血及缺血等并发症。结论采用电解脱弹簧圈联合机械微弹簧圈血管内栓塞夹层段椎动脉治疗硬膜内出血性椎动脉夹层是安全、有效的,不仅有利于降低再出血率，还可降低手术费用。

Objective To study the endovascular management of intradural hemorrhage spontaneous vertebral artery dissection （SVAD） with guglielmi detachable coils （GDCs） and mechanical coils, and explore its therapeutic effect. Methods Four patients with defined intradural hemorrhage SVAD by DSA, admitted to our hospital fxom January 2008 to December 2011, were chosen in our study; SVAD in 4 patients located in the proximate posterior inferior cerebellar artery. Endovascular management was adopted by evaluating their medical imaging and clinical data. The aneurysms were filled with GDCs, and the parent arteries were performed embolism with mechanical coils. Results No patient died; no aneurysms ruptured and no other severity complications happened during operation. Postoperative angiography showed complete occlusion of SVAD in 4 cases. No rehemorrhagia or ischemia happened during the 6-36 months of follow up. Conclusion Endovascular intervention with GDCs and mechanical coils is a safe and efficacious method for intradural hemorrhage SVAD, which can not only decrease the ratio of rebleeding, but decrease the surgery cost as well.