破裂和未破裂椎动脉瘤的血管内治疗

Endovasuclar treatment of ruptured and unruptured vertebral artery aneurysms

目的分析破裂与未破裂椎动脉瘤的成功血管内治疗。方法以在新乡市中心医院接受治疗的63例患者(共有65个椎动脉瘤,包括急性夹层和慢性大型动脉瘤)为分析对象,运用改良Rankin量表对临床结果进行评分。其中对44例患者进行了血管造影随访,为期3～16个月(平均8个月)。结果依据Hunt和Hess分级标准,未破裂动脉瘤34例,1级动脉瘤28例,2级动脉瘤1例。其中小脑后下动脉(PICA)远端动脉瘤25例,PICA近端动脉瘤22例,椎动脉-小脑后下动脉(VA-PICA)动脉瘤18例。63例患者中女12例,男51例。平均年龄为41.7岁(6～77岁)。63例患者中44例进行了血管造影随访。其中39例可以依据早期治疗后的血管造影片来确诊完全或基本完全的血栓形成。3例患者观察到了病灶轻微减小,而2例患者存在显著的残留病灶。临床随访表明90.5%的患者为mRS为0～2,4.8%的患者为mRS>2,以及4.8%的患者死亡(mRS为6)。1例患者死于再次出血,2例患者死于或进展性占位效应/脑干局部缺血。结论使用血管内技术可以很好地治疗破裂与未破裂的椎动脉动脉瘤,90.5%的患者长期治疗效果良好。

Objective To analyze the successful endovascular management of ruptured and unruptured vertebral artery aneurysms.Methods Sixty-three patients with 65 vertebral aneurysms（both acute dissection and chronic larger aneurysms were included） treated in our hospital were the objects.The clinical outcome was evaluated using the modified Rankin scale（mRS）.Angiographic follow-up data was obtained form 44 patients for periods ranging from 3 to 16 months（mean,8 months）.Results Based on the Hunt and Hess grading scale,there were 34 patients with unruptured aneurysms,28 patients with grade 1 aneurysms,1 with grade 2 aneurysms.The locations of the aneurysms included 25 at the distal end of posterior inferior cerebellar artery（PICA）,22 at the proximal end of PICA and 18 at the vertebral artery-posterior inferior cerebellar artery（VA-PICA）.Among the 63 patients,12 cases were women and 51 cases were men.The mean age at treatment was 41.7 years（range,6-77 years）.Follow-up angiograms were obtained in 44 out of the 63 patients.Complete or virtually complete thrombosis was confirmed on early posttreatment angiography in 39 out of the 44 patients.A slight reduction in the size of the lesion was noted in three patients and there was significantly residual lesion in two patients（4.5%）.Clinical follow-up revealed that 90.5% patients in the mRS 0-2 category,4.8%patients in the mRS＆gt;2 category,and 4.8% patients had died（mRS was 6）.One patient died of rebleeding,and 2 patients died of progressive mass effect/brainstem ischemia.Conclusion Ruptured and unruptured aneurysms of the vertebral artery can be well treated by endovascular techniques,overall long-term results are good in 90.5% of the patients.