闭塞法治疗破裂出血性椎动脉夹层动脉瘤的效果

OCCLUSION METHOD IN THE TREATMENT OF RUPTURE OF VERTEBRAL ARTERY DISSECTING ANEURYSM

目的探讨同时闭塞动脉瘤及载廇动脉治疗出血性椎动脉夹层动脉瘤的效果及并发症,并分析动脉瘤与小脑后下动脉（PICA）位置关系对预后的影响。方法椎动脉夹层动脉瘤破裂出血病人13例,其中PICA远端动脉瘤8例,PICA近端动脉瘤5例,采用弹簧圈栓塞动脉瘤体,并采用膨胀圈栓塞系统HydroCoil或COOK公司栓塞弹簧圈同时闭塞夹层动脉瘤及载廇动脉。临床随访2~36个月,4例采用DSA随访。结果术后即刻造影显示,全部病人夹层动脉瘤及载瘤动脉闭塞完全,PICA通畅;术后早期发生WALLENBEEG综合征1例,病变位于PICA近端,临床随访无再出血病人。结论闭塞法虽然对防止再出血疗效确实,但是容易引起穿支血管闭塞,导致延髓梗死,尤其是PICA近端的病变;随着血管内重建技术的不断进步,闭塞法应该慎用。

Objective To assess the efficacy and complications of occlusion of the aneurysm and load tumor artery in the treatment of ruptured vertebral dissecting aneurysm （VDA） and analyze the influence of the relationship between the aneurysm and the location of posterior inferior cerebellar artery （PICA） on the prognosis. Methods This study consisted of 13 patients with ruptured VDA, of which, eight cases of the tumor located at distal PICA, and five at proximal PICA. The bodies of aneurysms were embolized with coils, and their parent arteries were embolized using HydroCoil embolism system or Cook coil system at the same time. Follow-up period ranged from 2 to 36 months. Four of them were followed angiographically. Results An angiogra- phy taken immediately after surgery showed that all the VDA and load tumor arteries were occluded completely, and PICA flowed smoothly. Wallenberg Syndrome occurred in one patient in early was reported during the follow-up period. Conclusion Though postoperative stage, locating at proximal PICA. No re-bleeding occlusion method is effective to prevent recurrent hemorrhage, it is easy to cause occlusion of perforating branches, resulting to medullary infarction, especially for the lesions locating at proximal PICA. With the continued improving of endovascular reconstruction technique, the occlusion method should be used with caution.