症状性颈动脉狭窄伴发远端颅内动脉瘤的同期血管内治疗

Simultaneously endovascular treatment of both symptomatic carotid artery stenosis and coexistent unruptured intracranial aneurysm distal to the stenosis

目的探讨同期血管内治疗症状性颈动脉狭窄伴发远端颅内动脉瘤的技术可行性和安全性。方法收集2008-01-2014-12作者单位收治的症状性颈动脉狭窄伴发狭窄远端未破裂颅内动脉瘤患者共11例,均同期实施颈动脉狭窄支架成形术和颅内动脉瘤栓塞（或动脉瘤开口单纯支架置入术）,并对患者的临床、影像和血管内治疗情况进行回顾分析。结果11例患者中,颈动脉狭窄部位均在颈内动脉起始部,狭窄率65%～95%,平均（80.9±10.2）%,均成功置入支架（残留狭窄0～20%,平均4.1%）;合并11个狭窄远端未破裂颅内动脉瘤,大小2.0～6.5mm,平均（4.1±1.7）mm,9个行弹簧圈栓塞,其中6个即刻达到次全栓塞,3个完全栓塞,2个行动脉瘤开口单纯支架置入术。围手术期无手术相关并发症。临床随访5～79个月,中位数为20个月,未发生颅内出血,或治疗动脉相关的脑梗死、短暂性脑缺血发作。结论同期行症状性颈动脉狭窄支架成形术和其远端伴发的颅内未破裂动脉瘤介入治疗具有技术可行性,相对安全。

Objective To evaluate the technical feasibility and safety of simultaneously endovascular treatment for symptomatic carotid artery stenosis with coexistent unruptured intracranial aneurysm （AN） distal to the stenosis. Methods From January 2008 to December 2014, 11 patients with symptomatic carotid artery stenoses and concurrent downstream unruptured intracranial ANs underwent single-stage carotid artery stenting （CAS） and AN management by coiling or sole-stenting technique. The clinical manifestations, imaging characteristics, interventional management results were retrospectively analyzed. Results In these 11 cases, all the 11 C1 stenoses （rang： 65% -95 %, mean： 80.9 %±10.20 %） located at segmeng of internal carotid artery were corrected with CAS successfully （0-20% residual stenosis, mean 5.5%）. Meanwhile, 11 unruptured intracranial ANs （range 2-6.5 mm, mean 4.1 mm± 1.7 mm） underwent endovascuIar treatment： 9 were coiled exhibited immediate satisfactory outcomes with 3 totally, 6 subtotally occluded, and the other 2 managed by deploying stent in the parent artery to cover the AN orifice. No procedure-related complications occurred. During a median follow-up period of 20 months （range, 5-79 months）, no intracranial hemorrhage or the treated artery- related cerebral infarction, transient ischemia attach （TIA） occurred. Conclusions Our results suggest that interventional treatment for symptomatic carotid artery stenosis and accompanying ipsilateral intracranial AN at the same time is technically feasible and relatively safe.